PENN Medicine Magazine | Winter 2016 by Penn Medicine

WINTER 2016

THE POWER OF PARTNERSHIP:

ADVANCING CARE ACROSS GENERATIONS THROUGH PENN & CHOP COLLABORATIONS

Making a Difference in Liberia TEXT HERE Neighbors Become Allies in TEXT HERE Patients on Track Keeping

THE PREP

A New “Moonshot” Is Launched Against Cancer

Photo by Daniel Burke

During his visit, Vice President Biden met with Bruce Levine, Carl June, and Amy Gutmann.

Days after President Barack Obama announced the “moonshot” to find a cancer cure during his State of the Union address, Vice President Joseph Biden visited Penn’s Abramson Cancer Center (ACC) to kick off the national effort. The aim, he said, is to “accelerate the progress already under way – much of which is happening right here. “You’re on the cusp of some breakthroughs,” Biden said. “In my terms – not your medical terms – we are at an inflection point in the fight against cancer.” Carl June, M.D., director of translational research at the ACC, and Bruce Levine, Ph.D., director of Penn’s Clinical Cell and Vaccine Production Facility, took Biden on a tour of the research hub that will serve as the center of its pioneering personalized T cell therapy program. Afterward, Biden led a roundtable discussion with Penn experts in immunotherapy, cancer prevention, surgery, genomics, and more. Joining the discussion were Chi Van Dang, M.D., Ph.D.,

A flurry of clinical successes and endeavors from the Penn doctors followed: cancer vaccines trials, immunotherapies, big data, precision medicine, cancer recurrence, and early chimeric antigen receptor (CAR) therapy clinical trials for aggressive brain cancer. Emily Whitehead, the 10-year-old girl who is now cancer free after receiving CAR therapy three years ago to treat her acute lymphoblastic leukemia, was also in attendance with her parents. While researchers have made significant headway in the fight, they also agreed that the field is not without its challenges. “Cancer politics,” Biden said, are keeping people in their respective corners. Data sharing must continue and expand, but the silos at and among academic medical centers and drug companies need to be broken down to speed the progress. This year also finds the National Cancer Institute with its biggest budget increase in 10 years, but Biden stressed that

director of the center; Amy Gutmann, Ph.D., president of the University of Pennsylvania; and Francis S. Collins, M.D., Ph.D., director of the National Institutes of Health. “I’d like you to educate me,” Biden said to the group. “I’d like you to talk about what you think I should most be doing as I put this task force together.”

more support from the private and public sector and philanthropists is essential to get us closer to cures and better treatments for the host of cancers diagnosed every day – some, he recognized, more complex and deadly than others. – Steve Graff

10 DEPARTMENTS Left THE PREP A New “Moonshot” Is Launched Against Cancer 2 VITAL SIGNS Novartis-Penn Center for Cellular Therapeutics Unveiled

32 DEVELOPMENT MATTERS Entering a New Decade of Discovery 34 ALUMNI NEWS Progress Notes and Obituaries 40 EDITOR’S NOTE Near and Far 41 ONE LAST THOUGHT And the Word Is . . . Mustaches!

26 WINTER 2016 / VOLUME XXVII NUMBER 1

10 Miracles Large and Small: Penn and CHOP Partnerships That Pave the Way By Miriam Falco

In the past decade, as both eminent institutions have developed new interdisciplinary centers and programs, collaborations between Penn Medicine and the Children’s Hospital of Philadelphia have produced some remarkable advances. Among them are two in the field of gene therapy and one that resulted in the first bilateral hand transplant of a child.

18 Making a Difference in Liberia STAFF John R. Shea, Ph.D. Editor Graham P. Perry/NCS Studios Design / Art Direction ADMINISTRATION Susan E. Phillips Senior Vice President for Public Affairs Holly Auer, M.B.E. Director of Communications

By Lori L. Ferguson

On her returns to her family’s homeland, Venee Tubman, M.D. ’06, has been instrumental in efforts to introduce the screening of newborns for sickle cell disease and to offer treatment for affected children. A pediatric hematologist /oncologist, she is based in Boston.

myPennMedicine: Penn’s Patient Portal 23 By Susan Perloff

An example of cloud computing, myPennMedicine allows doctors and their staffs to communicate with patients and their families in a new, efficient way. Patients can schedule a visit or request a prescription refill – and even receive test results.

26 A Health Program with IMPaCT |

By Kevin Ferris

A Penn Medicine center works to improve the health of high-risk patients by matching them with community workers who provide support and help them navigate the health system. Many of the health workers come from the community they serve.

Penn Medicine is published for the alumni and friends of Penn Medicine by the Office of Public Affairs. © 2016 by the Trustees of the University of Pennsylvania. All rights reserved. Address all correspondence to John Shea, Penn Medicine, 3535 Market Street, Suite 60 Mezzanine, Philadelphia, PA 19104-3309, or call (215) 662-4802, or e-mail john.shea@uphs.upenn.edu.

Visit Penn Medicine’s web site: http://www.uphs.upenn.edu/news/publications/PENNMedicine/

VITAL SIGNS Novartis-Penn Center for Cellular Therapeutics Unveiled

Inside the CACT: Fast Facts $27 million in construction costs

23,610 square feet Physicians, scientists, and leaders from the Perelman 6,300 square feet of laboratory School of Medicine and Novartis, the global pharmaceutical of “clean room” and cell therapy company, gathered last month to unveil the Novartis-Penn space for cell engineering manufacturing space Center for Advanced Cellular Therapeutics (CACT). Located on Penn Medicine’s campus amid both clinical care and laboratory facilities, the new center is poised to become a major site for research and early development of personalized celluCapacity to manufacture lar therapies for cancer. It will expand on Penn’s groundbreakcellular therapies Staffed by 100 ing research using Chimeric Antigen Receptor (CAR) techfor up to 400 patients highly specialized cell nology, through which patients’ own immune cells are reproper year therapy professionals grammed outside of their bodies and re-infused to hunt for and potentially destroy their tumors. “In only a few years, we have generated significant achievePenn’s translational science efforts to expedite the development of ments that have moved the field of personalized cellular theranovel therapies for many types of disease. The collaboration with pies forward, opening clinical trials to test these treatments not Novartis was announced in August 2012, when the two organizaonly for patients with blood cancers, but also those with solid tions entered an exclusive global research and licensing agreetumors,” said Carl June, M.D., the Richard W. Vague Professor ment to further study and commercialize novel CAR therapies. in Immunotherapy in the Department of Pathology and Labo“The opening of the Novartis-Penn Center for Advanced ratory Medicine and diCellular Therapeutics is a rector of the Center for significant milestone in Cellular Immunotheraour collaboration with pies in the Perelman Penn,” said Mark C. FishSchool. “The CACT will man, M.D., president of allow us to leverage this Novartis Institutes for progress to develop and BioMedical Research. “It test new approaches is our hope that discovermore quickly and exies will be made at this pand our ability to manfacility that could one day ufacture personalized lead to new medicines to cell therapies for a help cancer patients greater number of trials.” around the world.” Left to right: Jonathan Epstein, M.D.; Ralph Muller; Glenn Dranoff, M.D., Novartis; Willam The new facility is a Ludwig, the first patient to receive CAR therapy; Bruce Levine, Ph.D.; Carl June, M.D.; marquee component of Chi Van Dang, M.D., Ph.D; and J. Larry Jameson, M.D., Ph.D. – Holly Auer

Danger: Sugary Beverages! Health warning labels similar to those found on tobacco products may have a powerful effect on whether parents purchase sugar-sweetened beverages (SSB) for their children. That is the finding of a new study, the first of its kind, led by the Perelman School of Medicine. Results show that regardless of a parent’s level of education, they may be significantly less likely to purchase an SSB when there is a label warning that consuming beverages with added sugar may contribute to obesity, diabetes, and tooth decay, compared to a label that only lists the calorie count, or no label at all. The results, published online in the journal Pediatrics, show that SSBs – including soft drinks and juices marketed for children – contain as many as seven teaspoons of sugar per 6.5 ounces. That is nearly twice the recommended daily serving of sugar for that age group. “In light of the childhood obesity epidemic and studies suggesting that more than half of children under 2

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the age of 11 drink SSBs on a daily basis, there is a growing concern about the health effects associated with consumption of these beverages,” said lead author Christina Roberto, Ph.D., an assistant professor in the Department of Medical Ethics & Health Policy While the specific text of the health warning labels did not affect a parent’s purchase choice, the presence of the label was significant. Overall, 40 percent of parents in the groups exposed to health warning labels said they would choose an SSB for their kids, compared to 60 percent of participants who saw no labels on the beverages, and 53 percent of parents who saw the calorie labels. The study also evaluated consumer support for sugar-sweetened beverage warning labels and found that nearly 75 percent of participants would support adding them to the containers. – Katie Delach

Honors and Awards National Academy of Medicine Elects Three from Penn Three professors from the University of Pennsylvania have been elected to the National Academy of Medicine, one of the nation’s highest honors in biomedicine. Members of the academy, originally the Institute of Medicine, are elected by their peers for distinguished contributions to medicine and health. The new members bring Penn Medicine’s total membership in the prestigious group to 66. The new members from the Perelman School of Medicine are Sean Hennessy, Pharm.D., Ph.D., a professor of epidemiology in the Department of Biostatistics and Epidemiology, and Frances E. Jensen, M.D., chair of the Department of Neurology. Hennessey received his Pharm.D. degree in clinical pharmacy from the Philadelphia College of Pharmacy and Science and his Ph.D. degree in epidemiology from Penn. He is a former president of the International Society for Pharmacoepidemiology and has served on the FDA’s Drug Safety and Risk Management Advisory Committee. In 2015 he began a threeyear term on the board of directors of the American Society for Clinical Pharmacology and Therapeutics. Hennessy is also a co-editor of two textbooks in the field. Among his honors is the 2013 Samuel Martin Health Evaluation Sciences Research Award from the Perelman School of Medicine. Jensen, co-director of the Penn Medicine Neuroscience Center, received her medical degree from Cornell University and was chief resident in neurology at The Harvard Longwood Neurology Training Program. She has investigated mechanisms of epilepsy as well as their age-dependent differences, with attention to the interactions between brain development, brain injury, epilepsy, and cognition. In addition to receiving the NIH Director’s Pioneer Award and the American Epilepsy Research Recognition Award, she was president of the American Epilepsy Society. A fellow of the American College of Physicians, she is author of a widely acclaimed book, The Teenage Brain: A Neuroscientist’s Survival Guide to Raising Adolescents and Young Adults (2015). The third new member of the National Academy of Medicine is Dennis E. Discher, Ph.D., the Robert D. Bent Professor of Chemical and Biomolecular Engineering in the School

of Engineering and Applied Science. He received his Ph.D. degree jointly from the University of California at Berkeley and at San Francisco. He is a member of graduate groups in cell and molecular biology, pharmacology, and physics. His research has focused on stem cell differentiation in relation to mechanics of microenvironments that differ between tissues and in disease. Discher is the principal investigator at Penn of a Physical Sciences Oncology Center, funded by the National Cancer Institute, which fosters research into new physical principles in cancer development. Charles S. Abrams, M.D., G.M.E. ’91, the Francis C. Wood Professor of Medicine, Pathology, and Laboratory Medicine, began his term as president of the American Society of Hematology (ASH) in December. ASH is the world’s largest professional society of hematologists dedicated to furthering the understanding, diagnosis, treatment, and prevention of disorders affecting the blood. At Penn Medicine, Abrams serves as vice chair for research and chief scientific officer of the Department of Medicine and director of the Blood Center for Patient Care & Discovery at Penn and The Children’s Hospital of Philadelphia. His clinical and research interests have focused on the role of platelets in bleeding and clotting disorders, inflammation, and metastasis formation. Abrams has been elected to the American Society of Clinical Investigation. Joseph E. Bavaria, M.D., G.M.E. ’90, the Brooke Roberts – William Maul Measey Professor in Surgery, was elected the 2016 president of the Society of Thoracic Surgeons. The society represents more than 7,100 cardiothoracic surgeons, researchers, and allied health care professionals worldwide. Bavaria, a member since 1996, has served on the operating board of the society’s Council on Health Policy and Relationships. A former chief resident of surgery at HUP, he serves as director of the Perelman School’s program in thoracic aortic surgery. Continues next page WINTER 2016

VITAL SIGNS Honors & Awards Continued Dennis R. Durbin, M.D., M.S.C.E., G.M.E. ’96, a professor of pediatrics at the Children’s Hospital of Philadelphia in the emergency medicine division and director of the hospital’s clinical and translational research, received the 2015 FOCUS Award for the Advancement of Women in Medicine. Durbin was recognized for his outstanding advocacy and dedicated mentorship on behalf of women faculty and trainees as well as for his exemplary roles as researcher, educator, and a clinician dedicated to supporting the integration of work and life. Durbin’s research has focused on preventing motor vehicle injuries to children and preventing crashes by teen drivers. His research has contributed to enhancements in public policy and safety technology that have led to substantial reductions in the number of children killed in automobile crashes each year. Over the past two decades, he has been a mentor to more than 30 trainees and junior faculty members, many of whom are now thriving in independent research careers. He has developed new training materials specifically focused on worklife integration. Durbin also established the Joanne Decker Memorial Work/Family Mentoring Award, in honor of his late wife, who was also a physician. The annual award honors a female CHOP faculty member committed to academic success and work-life balance. Terence Peter Gade, M.D., Ph.D., G.M.E. ’15, an assistant professor of radiology and cancer biology, received a five-year, $2 million 2015 NIH Director’s Early Independence Award, part of the High-Risk, High-Reward Research program. The award supports “exceptional early career scientists with the intellect, scientific creativity, drive, and maturity to flourish independently by bypassing the traditional post-doctoral training period.” Gade’s project deals with hepatocellular carcinoma, also known as liver cancer. This year, an estimated 35,660 adults in the United States will be diagnosed with primary liver cancer. Gade reports that liver cancer cells can adapt their metabolism to survive the severe metabolic stress caused by current treatments, and widely used imaging techniques, primarily MRI and CT, cannot detect these surviving cells. “By combining a better understanding of how

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surviving cancer cells adapt with novel imaging technology making use of carbon-13 based compounds, this study will take important steps toward the development of clinical imaging that can detect surviving cancer cells. Detecting these cells is the vital first step in eradicating them.” Erika L. F. Holzbaur, Ph.D., a professor of physiology, received the 2015 F. E. Bennett Award. Presented annually by the American Neurological Association, it recognizes an outstanding researcher and educator in neurology. Holzbaur is known for her research and teaching on molecular motors, which function as tiny machines to propel organelles within a cell. Inhibiting or enhancing their activity has potential therapeutic beneﬁts, while transport defects can cause disease. Intracellular transport by molecular motors is particularly important in neurons, the impulse-conducting cells that comprise the brain, spinal column, and nerves in vertebrates. Holzbaur is also the recipient of one of the Perelman School’s Awards of Excellence for 2015. She was honored with the Stanley N. Cohen Biomedical Research Award, which recognizes a faculty member for a body of work with an emphasis on biomedical research. According to the award citation: “her work is not only fascinating from a fundamental biology perspective, but has significant implications for understanding the etiologies of many diseases.” Anil K. Rustgi, M.D., chief of the gastroenterology division in the Department of Medicine, has been honored for a second time with a Research Professor Award from the American Cancer Society. The awards are given to outstanding scientists and clinician-scientists who have made seminal contributions to their fields, are thought leaders in their fields, and have made outstanding efforts in terms of service and mentoring. The society’s award comes with a grant of five years for Rustgi to continue to provide leadership in his research on the genetics and biology of gastrointestinal cancers, including those arising from the colon and pancreas. The Rustgi lab has long focused on the tumor microenvironment and how preneoplastic cells become neoplastic. Rustgi is the T. Grier Miller Professor of Medicine and Genetics.

What Neighborhood Factors Are Linked to Urban Violence?

Gunshot violence is the leading cause of death among 10to-24-year-old range African American males and the second leading cause of death among 10-to-24-year-olds males overall in the United States. A new Penn Medicine study is the first to outline the details of how an individual’s location and activities influence that risk. The research maps the 24-hour paths and activities of more than 600 males in the 10-to-24-year-old range, primarily African Americans. Of the group, 143 had been shot with a gun, 206 were injured with another weapon, and 283 were unharmed controls. Those who had been assaulted were recruited after being cared for in the emergency departments of the Level 1 trauma centers at the Hospital of the University of Pennsylvania and the Children’s Hospital of Philadelphia. Researchers asked the young men to recount the 24 hours before they had been attacked, and the control subjects described a random day within three days of their interview. Reported in the journal Epidemiology, the findings showed that what the subjects were doing and where they were either protected them or dramatically increased their likelihood of assault. In effect, just one turn down a certain city street can increase the risk of being a victim of violent crime. The risk of gun assaults was higher among those who were alone, those who had recently acquired a gun, and those located in an area with many vacant houses and/or a history of violence and vandalism. The risk for assaults not involving guns was higher near recreation centers, among individuals who had recently consumed alcohol, and in areas of high vacancy, overall violence, and vandalism.

Subject Path Point High Low

“Even once risks are pinpointed, it may be hard to get people to change behavior – to have them not walk down a certain street or not carry a gun, for instance,” said the study’s lead author, Douglas J. Wiebe, Ph.D., an associate professor of epidemiology in the Department of Biostatistics and Epidemiology. “But if we can change urban environments to make them safer, we can protect all people who come into contact with those places.” Areas where neighbors were more connected – where subjects reported that residents worked together on projects such as neighborhood watches and block parties – experienced lower rates of assaults. In addition, the control group spent more hours in their homes than the other participants did. The research team developed an original geography software application to comprehensively plot out each subject’s location by latitude and longitude; then the researchers superimposed a map layer that showed the characteristics – risky or protective – of the areas the subjects moved through. – Gregory Richter

PENN TOWER: WHAT IS OLD IS NEW AGAIN As Penn Tower comes down, Penn Medicine and demolition contractors are working to recycle its contents and demolition debris for future use, saving money and reducing waste. Here is a snapshot of the materials recycled to date.

RECYCLED

291

net tons of scrap steel which will be used in future construction

291

tons of recycled steel

weight of

blue whales

17,000

net tons of concrete, being re-used at the construction site as a bed for construction vehicles

17,000

tons of concrete

3 = weight of /4 Eiffel Towers WINTER 2016

VITAL SIGNS

The Impact of Trauma on the Teen Brain

Frances Jensen, M.D., chair of Penn’s Department of Neurology, epilepsy researcher, and neuroscientist, was a recent visitor to UNICEF’s headquarters in New York City. She is also the author of a New York Times bestseller, The Teenage Brain: A Neuroscientist’s Survival Guide to Raising Adolescents and Young Adults, published in early 2015. Jensen was invited to share her expertise with the UNICEF staff, many of whom are engaged in projects and programs related to advocacy, disease and abuse prevention, education, protection, gender equality, and more for children and adolescents around the world. Jensen’s book is one of the first directed to a lay audience that dissects the inner workings of the teenage brain and the science behind teen behavior. In it, Jensen debunks the longheld scientific hypothesis that the adolescent and teen brain is essentially an adult brain, only with fewer miles on it. At UNICEF, she presented the recent discoveries about the effects of stress, environment, and physical and emotional violence on brain development. “This is profoundly important to our work,” said Anthony Lake, UNICEF’s executive director. He pointed out that if the organization can demonstrate “that when there is stress, there is a lack of learning and its effects can be permanent, not just for a short period,” UNICEF could have a greater impact through its work in parts of the world where living situations are difficult and complex. As Jensen explained, the brain’s frontal and prefrontal cortex – which controls executive functions such as decisionmaking, impulse control, and risk-taking behavior – are not yet fully connected in the teen and adolescent years. Connection, or insulation of the brain’s neuronal tracks, starts in the back of the brain and works its way forward, and the process is not complete until sometime in an individual’s mid-to-late 20s. This long period may help explain why teens often seem to be lacking in insight and empathy. The teenage years, Jensen emphasized, are also a time of great synaptic plasticity, when the brain is molded by different situations and circumstances. Teenagers can learn a language faster than they would as adults and remember facts better, but the effects of behaviors can be much more permanent on the brain. Addiction is a form of learning, and this synaptic malleability means teenagers become addicted faster. Whether heavy drinking or drugs, habits formed during this period are 6

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imprinted in the teen’s brain and are much harder to break. Similarly, “environmental factors such as stress and violence can stall brain development,” Jensen told the audience. Synapses, or brain connections, operate on a “use them or lose them” basis. The brain needs to prune these connections naturally and customize itself for its surrounding environment. Factors such as a lack of education will force the brain to prune important synapses that will be deemed unnecessary by the brain; those synapses are never to be regained. In addition, the release of the stress hormone cortisol halts the development of synapses. The implications for UNICEF’s charges – the world’s most vulnerable children – are clear. Children and adolescents living in violence in Syria or elsewhere in the world who are exposed to negative stimuli and stressful situations, without the benefits of a well-connected frontal lobe, are at particularly high risk for negative outcomes. Their judgment is not developed enough for the stimuli they face, which often leads to cycles of violent behavior continuing into the next generation. In addition, the negative stimuli constantly present in social media can be harmful to the developing brain. The teenage years are also classically the time of onset for mental illness. “Adults need to be vigilant and tell the difference between a moody or belligerent teen and a teen falling down the rabbit hole of mental illness or a life of addiction or violence before it’s too late,” Jensen said. The teen brain, she suggested, is like a Ferrari with no brakes. “There is no seven-year period that has a greater impact on a person’s life or society,” Jensen said in closing. (For more on Jensen, see “Honors & Awards.”) – Lee-Ann Donegan

Penn Medicine IT Among Top in Nation

The American Association of Medical Colleges has awarded Penn Medicine’s Information Services team a Learning Health System Research Pioneer Award for its work to enhance and align the research and clinical domains of Penn Medicine. Dubbed Clinical Research+, the strategic set of projects leverages technology, processes, and people to analyze and share clinical and research data within Penn Medicine. “This prestigious award recognizes the significant achievement Penn Medicine has made towards advancing our Precision Medicine efforts,” said Michael Restuccia, vice president and chief information officer for Penn Medicine. (Restuccia was recently named one of Computerworld’s Premier 100 Technology Leaders for 2016.) Initiatives under the Clinical Research+ umbrella include centralized clinical and research data warehouses, centralized lab information management and clinical trials management systems, and a center for personalized diagnostics. The common theme for these initiatives is the effort to enhance the value of clinical and research data by better enabling staff and faculty on both sides of Penn Medicine to access and utilize these data. Penn Medicine was one of four institutions awarded this honor.

Transitions Jack Ludmir, M.D., G.M.E. ’87, who has served as chair of the Department of Obstetrics and Gynecology at Pennsylvania Hospital since 1998, will step down from that position in the Spring of 2016. During that time, he has also been vice chair of the Department for the Perelman School of Medicine. An expert in maternal-fetal medicine, he is known for his compassion in caring for the underserved and uninsured in the Greater Philadelphia area and in Latin America. He is a co-founder of both Puentes de Salud and the Latina Community Health Services. Ludmir’s first faculty appointment was in 1987, when he was named an assistant professor of Ob-Gyn at Penn. A Fellow of the American College of Obstetricians and Gynecologists, he has received honorary degrees from two Peruvian universities and was named an Honorary Professor by a third. In addition, he has received several teaching honors, including the Excellence in Teaching Award from the Association of Professors of Gynecology and Obstetrics in 2002 and 2006. In 2007 he received the Alfred Stengel Health System Champion Award, which recognizes a Penn Medicine physician who has made significant contributions toward the clinical integration of the University of Pennsylvania Health System. In January, Women’s

and Children’s Health Services at Pennsylvania Hospital was renamed the Ludmir Center for Women’s Health. Nancy A. Speck, Ph.D., a leader in the field of blood cell development, was named chair of the Department of Cell and Developmental Biology. She is also the associate director of Penn’s Institute for Regenerative Medicine and an investigator in the Abramson Family Cancer Research Institute. Over the course of her more than 30-year career, Speck has made many important contributions toward our understanding of the formation and development of blood cells and has translated these findings to fighting leukemia. (Genes required for blood cell formation and function are often mutated in human leukemia.) She has published more than 100 peer-reviewed articles in leading journals and has served on and chaired study sections at the National Institutes of Health, the American Society of Hematology, and the Leukemia and Lymphoma Society. Her honors include the 2015 Henry M. Stratton Medal for Basic Science from the American Society of Hematology for her “seminal contributions in the area of hematology research.” Speck came to Penn Medicine from Dartmouth Medical School, where she held the James J. Carroll Chair of Oncology. She succeeds Jon Epstein, M.D., who has assumed the role of executive vice dean and chief scientific officer of Penn Medicine.

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They Said It There’s a widespread perception that the U.S. spends a tremendous amount on end-of-life care, but until now there’s never been a comparative study to put U.S. spending and resource utilization in context,” said Ezekiel J. Emanuel, M.D., Ph.D., vice provost for global initiatives, the Diane v.S. Levy and Robert M. Levy University Professor, and chair of the Department of Medical Ethics and Health Policy. “End-of-life care is intensive and expensive, and what we know now is that the U.S. does not have the worst end-of-life care and that no country is optimal. All countries have deficits.” Emanuel is senior author of an international comparison of end-of-life care practices, published in JAMA in January.

Although most people know that exercise is good for their health, more than 50 percent of adults in the United States don’t get enough of it,” said Mitesh S. Patel, M.D., M.B.A. ’09, M.S. ’14, an assistant professor of medicine and health care management in the Perelman School of Medicine and the Wharton School. “Workplace wellness programs aimed at increasing physical activity and other healthy behaviors have also become increasingly popular, but there’s a lack of understanding about how to design incentives within these programs. Our findings suggest that these programs could result in better outcomes if they designed financial incentives based on principles from behavioral economics such as loss aversion.” Patel is lead author of an article in the Annals of Internal Medicine published in February. WINTER 2016

VITAL SIGNS LETTERS What Fracking Balance?

Penn’s Center of Excellence in Environmental Toxicology (CEET), and its director, Dr. Trevor Penning, deserve kudos for seeking scientific truth surrounding unconventional gas and oil drilling, hydraulic fracturing (“Fracking and Public Health: Finding the Best Balance,” by Mark Wolverton, Penn Medicine, Fall 2015). Indeed, a bright spotlight must be placed on this process, as, when conducted irresponsibly, potential irrevocable environmental damage can be and has been foisted upon Pennsylvania and its population. Honest illumination of the environmental and health effects of fracking requires all players in the oil and gas industry to be forthright in divulging information that the public and CEET have a right to know, but the industry has, to date, been unwilling to provide, through obfuscation and subterfuge, rendering CEET’s mission a high-stakes challenge. Wolverton writes the dearth of “hard data” and the difficulty of procuring “proprietary” recipes for fracking fluid. He admits that “we don’t have a strong handle on the pollutants that might contaminate the water supply.” This is an understatement! We know extraordinarily little about what is in fracking fluid when we should have a right to know. It has been postulated that there are carcinogens in the fluid. It is well known that the industry is refusing to permit third-party testing. There are approximately 280 unrelated chemicals that have been studied for environmental and public health effects. However, there are about 80,000 chemicals (not to mention the infinite interactions between them) that our bodies have to handle. How has this become acceptable? Wolverton writes

998 1000 999997 996 995 993 991 8

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994

992

that “Panettieri and his colleagues emphasize the study’s limitations and caution against drawing premature and unfounded conclusions.” While reasonable, a paralysis of analysis can lead to delayed necessary action. How much data is needed before a moratorium is set and the precautionary principle is followed to do nothing if one doesn’t know if something could be harmful? As a physician, I took the Hippocratic Oath to “above all do no harm.” Shouldn’t the natural gas extraction companies behave similarly? For some reason, those who pollute operate from the misconception that there is an “away” when, in actuality, many chemicals we toss into

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Unfortunately, millions of gallons of water are used for this process. This precious resource is therefore unavailable for other necessary uses. Noise pollution is also an issue with this process.

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the heap (landfills, waterways, air . . .) eventually will come back and settle in our bodies naturally. All of these industries unfortunately pollute us. Marilyn Howarth asserted “that there is no data to determine if these changes are occurring and, if they are, what are the impacts on people’s health.” Dr. Panettieri was quoted, “I’m confident that as time goes by, you’re going to see more and more studies showing health consequences rather than safety.” The conundrum stems from gas extraction companies’ refusing public access for accurate scientific testing of the well

1,000 and Counting

Last fall, Gordon Baltuch, M.D., Ph.D., reached an impressive landmark, performing his 1,000th deep brain stimulation surgery (DBS). Around the world, the intricate surgery has helped more than 100,000 Parkinson’s disease patients to reduce their tremors and involuntary movements when medications fail. Baltuch, professor of neurosurgery and director of the Center for Functional and Restorative Neurosurgery, is a pioneer in the treatment, having led a surgical team at Pennsylvania Hospital for all 1,000 cases. DBS is performed by placing two insulated wires into the subthalamic nuclei, two structures the size of Rice Krispies, deep in the brain. The procedure renders these parts of the brain inactive without surgically destroying them. The wires connect to a stimulator that sits below the collar bone. As Baltuch explains, “We use electricity to modulate the brain’s circuitry in order to dial back the motor symptoms of Parkinson’s disease.” Once implanted, the stimulator is “turned on” and programmed to achieve optimum results for each patient. “Our movement disorder neurologists program the stimulators and adjust patient’s medications,” Baltuch says.

heads and the streams below them on the property to show the true sources of any pollutants. After 30 years, most wells leak, according to available data. Experts at CEET recommend “establishing a health registry to track and monitor the health of residents living near fracking sites. . . . That data . . . should be based on a particular ill effect or symptom as diagnosed by a physician trained in taking exposure history. Unfortunately, . . . we have . . . a lack of physicians that are actually trained in occupational environmental medicine.” While this is true, it is not the whole issue. Natural gas extracting companies have insisted upon legislation that gags physicians from asking about symptoms and assessing problems associated with fracking as well as reporting them. In addition, folks who live near the shale gas well sites suffer dropping property values and bankruptcy on a regular basis. The problem with this industry is not just pollution. Mr. Wolverton quotes Marilyn Howarth: “Exemptions to environmental laws are generally reserved for processes that have been thoroughly researched and found to be safe. Hydraulic fracturing enjoys the exemption from major environmental laws without being thoroughly researched or having very many restrictions.” Isn’t that a shame? Thanks go to Dick Cheney and his work with his cronies at Halliburton, during the Bush administration. Dr. Penning thinks “the best we can do is identify the potential risks and manage them by having the industry adopt safe practices.” He thinks “that some in the industry would like to make sure that there are useful best practices, because they do not want the industry to become overregulated because of some bad actors. There is a middle ground. . . .” Just who does Dr. Penning think will enforce these safe practices when these wealthy companies have teams of lawyers to facilitate maximal profits during the gas gold rush? Overregulation? Seriously? Unfortunately, millions of gallons of water are used for this process. This precious resource is therefore unavailable for other necessary uses. Noise pollution is also an issue with this process. We know we have energy needs but, to meet them, why don’t we rapidly expand those sources that don’t cost so much regarding the environment and public health? As much as we can, we need to leave fossil fuels in the ground. According to the Union of Concerned Scientists, expansion of natural gas is not the right way to address climate change. See www.ucsusa.org for more information. China is leading the way in developing renewable energy and has even robustly moved forward with Cap and Trade with carbon pricing. We have no more time to waste in catching up. We could probably decrease our energy use as country by 25-30% within a month’s time with rigorous efforts to eliminate waste of energy. Turning off and using less is anathema to the American way, where many people suffer from “affluenza” and consume in excess. I would encourage your readers to view Gasland and Gasland 2, produced by Josh Fox. When you see these problems with your own eyes, will they be lying to you? Such a dirty process is permitted in our midst.

Indeed, procuring enough money to fund the scientific process that CEET is pursuing will be a challenge. The University of Pennsylvania has a multi-billion dollar endowment. I have personally given money to the process of learning more about fracking and I would encourage any alumnus or alumna to do the same. As you read this, the gas industry is desperately trying to turn Philadelphia into a major natural gas energy hub. You might wish to investigate this and have your voice heard. I look forward to more scientific output from CEET. L. Matthew Schwartz, M.D., G.M.E. ’89, a specialist in physical medicine and rehabilitation, is affiliated with Chestnut Hill Hospital. He is on the National Advisory Board of the Union of Concerned Scientists.

Saluting Jonathan Rhoads

I wished to compliment Mr. Art Carey and Penn Medicine on your very perceptive and truthful article on one of Penn Med’s greatest products and Christian human beings, Dr. Jonathan Evans Rhoads Sr. [Spring 2015]. His family saga with the Chu family was certainly not the only one of greatness in his mentoring. I would like to direct my contributions to Penn Med to the Harrison Dept. of Surgical Research, if that department still exists, in memory of Dr. Rhoads. Frank E. Davis III, M.D., F.A.C.S, G.M.E. ’74 Editor’s Note: Dr. Rhoads was director of the Harrison Department of Surgical Research, which continues as the research arm of the Department of Surgery.

What About the Odor?

In his review of Dr. Kelly Parsons’s novel Doing Harm, John Shea quotes a passage wherein the main character describes a surgical procedure. “As the tissue at the point of contact between the Bovie’s metal tip and the patient vaporizes, it produces a wisp of bluish-tinged smoke that carries a singular odor. The odor of burning human flesh. I pick up the Bovie and cauterize the bleeding vessels. The heat of the Bovie cooks the fat, and I inhale the familiar smell. God, I love operating.” Doctors are often accused of playing God. In chapter 8 of Genesis, Noah “. . . offered burnt offerings on the altar. The Lord smelled the pleasing odor, and the Lord said to himself, ‘Never again will I doom the earth because of man’ . . .” The symbolism is so obvious it cannot possibly be inadvertent. Elliot B. Werner, M.D. ’71 WINTER 2016

MIRACLES LARGE AND SMALL: PENN AND CHOP PARTNERSHIPS THAT PAVE THE WAY

By Miriam Falco

hiladelphia can claim both the first medical school in America and the nation’s first hospital devoted exclusively to the care of children. When the University of Pennsylvania moved to West Philadelphia in 1872, it was a bold step that allowed for greater and more thoughtful expansion. Two years later, Medical Hall opened. Formal affiliation between the medical school and the Children’s Hospital of Philadelphia came in 1930. Then, in 1974, the hospital also came west to its present location, next to Penn’s campus. CHOP physicians are members of the Perelman School of Medicine’s faculty, but the collaborations between the two institutions go far beyond a single department. 10

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In the past decade, these joint efforts have produced remarkable advances as both eminent institutions have grown and developed new interdisciplinary centers and programs. CHOP’s Main Building abuts the Ravdin Building of the Hospital of the University of Pennsylvania on 34th Street. But adjacent newer buildings serve as a metaphor for the constant growth of both institutions and their shared mission to promote health for people of all ages. Penn Med’s Clinical Research Building (emblazoned with a giant Penn shield) and Biomedical Research Building II/III look across Osler Circle at CHOP’s Abramson Pediatric Research Center and Wood Pediatric Ambulatory Care Center. And on Civic Center Boule-

COVER STORY vard, the newest of the new – and less traditional – edifices have risen: CHOP’s Colket Translational Research Building and the Buerger Center for Advanced Pediatric Care can nod to the Perelman Center for Advanced Medicine, the Smilow Center for Translational Research, the Roberts Proton Therapy Center, and the Jordan Center for Medical Education. Collaboration is only a few footsteps away. The many joint programs housed in these and other buildings on the two campuses span just about every bodily system and collection of conditions, including the Penn-CHOP Transition Center for Digestive, Liver, and Pancreatic Medicine, with two directors, one from each organization. The group’s work seeks to ensure a safe and smooth transition from pediatric to adult care, which can be wrenching when young patients leave behind the well-established regimens they’ve grown accustomed to. A similar program, the Philadelphia Adult Congenital Heart Center, also helps young adults with congenital heart conditions, who are living well into adulthood after decades of advances in treating their conditions. One of the principal goals of Penn Med’s Institute for Translational Medicine and Therapeutics is to bridge the pediatric-to-adult divide in the understanding of physiology and disease. The recently established PennCHOP Microbiome Program focuses on the rapidly expanding field that studies the vast number of miBennett crobes that colonize our bodies and influence our long-term health. Another complex that welcomes both adults and children is the Center for the Treatment and Study of Anxiety. A newer addition in the area of psychiatric care is the Penn Center for Youth and Family Trauma Response and Recovery, recently profiled in Penn Medicine). Among the recent successful collaborations between Penn and CHOP are two in the field of gene therapy – going very far in reviving an area of medicine that had long suffered false starts and serious setbacks – and one that resulted in the first bilateral hand transplant of a child. Each of these advances has an almost science-fiction-like quality that has aroused new public interest in medical conditions once thought to be untreatable.

were just being discovered. Bennett and Maguire began their collaboration – and life together – long before they came to Penn. They met as firstyear medical students at Harvard. Both developed an interest in vision and, it turned out, in each other – they married a couple of years later. Early on, Bennett knew she wanted to develop gene-based treatments. Maguire was studying ophthalmology. After medical school, as Bennett tells it, Maguire was building his clinical career. “In one of our conversations, he asked, ‘do you think gene therapy could be used to treat retinal disease?’ That was in 1985.” Back Maguire then, none of the genes that caused eye disease had even been identified, so all the reagents used in creating a gene therapy had yet to be studied and developed. This is when Bennett and Maguire began collaborating to find a way to LCA. Both were recruited to Penn’s Department of Ophthalmology in 1992. Bennett continued her basic research, while Maguire spent most of his time in the clinic. Whenever he had free time, she points out, he came to the lab and used his skills, including his surgical skills. They spent a good part of the 1990s building the infrastructure for future clinical trials. That included developing the means to transport the necessary genes and the surgical procedures to inject the gene therapy – healthy RPE65 genes – into an eye. In 1996, they had success in tests transferring genes in mice with retinitis pigmentosa. “The first time this worked in a large animal was a dog in 2000,” Bennett says. They had successfully transferred healthy genes into eyes of dogs that had a genetic mutation causing LCA. A single in-

MENDING BROKEN GENES

For ophthalmologists, making the blind see would be the greatest achievement. Jean Bennett, M.D., Ph.D., the F. M. Kirby Professor of Ophthalmology, and Albert Maguire, M.D., a professor of Ophthalmology, have developed a therapy to treat a retinal disease caused by mutations in the eye’s RPE65 genes. Without treatment, individuals with Leber congenital amaurosis (LCA) – an inherited disease that affects the retina’s ability to respond to light – eventually lose their sight. But developing the therapy took a lot of patience, perseverance, hard work, and collaboration, at a time when gene therapy was little more than a distant hope because genetic mutations

Christian Guardino, an LCA patient

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jection of healthy RPE65 genes was restoring the dog’s vision. The next step would be human clinical trials. But that would not be easy, because human testing in the entire gene therapy field came to a stop following the death of 18-year-old Jesse Gelsinger. He died in 1999 after participating in a clinical trial at the University of Pennsylvania. Although Bennett’s and Maguire’s meticulous work in animal models provided the evidence that their gene therapy approach might help humans vision improve, they were faced with fresh challenges to meet the new stricter regulatory and ethical requirements for conducting human tests. Enter Katherine High, M.D., then the William H. Bennett Professor of Pediatrics in the Perelman School and an investigator of the Howard Hughes Medical Institute. As the director of CHOP’s Center for Cellular and Molecular Therapeutics,

The first experiments were in adults because there was concern about what the trial would do to the patients’ eyes. The first three patients to be injected with healthy versions of the RPE65 gene were young adults. Their improvements in seeing light better were good enough and the safety of the therapy meant that the trial would continue with children.

she was able to offer vast and expert resources for launching a clinical trial. High’s team developed the vector – that is, the vehicle – that would carry the new gene to the cells in the eye. This Penn Med-CHOP team still had to convince the U.S. Food and Drug Administration, the National Institutes of Health, and two institutional review boards, as well as other committees, that this clinical trial should proceed. Even though they were studying an eye disease that begins in childhood, the team was asked to conduct the first experiments in adults because there was concern about what the trial would do to the patients’ eyes. Before research is conducted in children, there must be either adequate safety and efficacy information from trials conducted in adult participants (given that adults are more capable of weighing the risks and benefits of study participation and making an informed decision) or sufficient justification for why adult studies cannot be conducted before conducting the research in children. In addition, the children must stand either to benefit individually from research participation or there must be a sufficient argument 12

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that, while direct benefit for each participant may not occur, the information gained from the conduct of the research would contribute to generalizable knowledge in a condition that is found only in children. In 2007, they were ready. The first three patients to be injected by Maguire with healthy versions of the RPE65 gene developed by Bennett were young adults. The results were encouraging – the patients weren’t cured and were still legally blind. But their improvements in seeing light better were good enough and the safety of the therapy meant that the trial would continue. There were five children in the initial safety trial. One of them was Corey Haas, then eight years old. Already legally blind because he was missing the functioning RPE65 gene, he was on the way to total blindness. At CHOP, Maguire injected the gene therapy with a healthy version of the gene into Corey’s worse eye. By the time he was nine, Corey was able to do many of the things healthy children his age could do – see colors better, read print (albeit large-sized, but no longer braille), ride a bike, and play baseball. Today, he’s no longer legally blind and so far his improved vision has been sustained. Another boy who went through the LCA trial is Christian Guardino. He received his injections in 2013 and had his twoyear follow-up last summer. Now a 10th-grader on Long Island, N.Y., Christian made the news in January when he sang at the New York Stock Exchange as part of a celebration of the Apollo Theater’s birthday 82nd birthday. Christian won the 2014 Grand Prize in the theater’s amateur “Apollo Stars of Tomorrow” category. The subsequent trials progressed well. Last October, phase 3 results of the clinical trial were published, indicating that patients who received the gene therapy met the primary endpoint of functional vision compared to the control groups. The trial is now run by Spark Therapeutics, a company launched in 2013 with a $50 million investment from CHOP, [and the company licensed the treatment]. Buoyed by these encouraging results, the company expects to file for FDA approval this year. If approved, it would be the first gene therapy treatment to reach that point. At the same time, Penn’s involvement with Spark has continued to expand, and High has left Penn and CHOP to become president and chief scientific officer of the company. “We did it, thanks to the interactions between CHOP and Penn,” Bennett says. “All the progress has involved a huge team of people with huge complementary expertise.” In addition, this successful Penn-CHOP collaboration led Penn Medicine to launch the Penn Center for Advanced Retinal and Ocular Therapeutics (CAROT) in 2014. Bennett and Maguire serve as co-directors. The center functions as a knowledge base to provide interested investigators with guidance on constructing vector gene therapy, designing clinical trials, and identifying and enrolling patients. Bennett is already working on treating another slowly progressing inherited eye disease that leads to blindness: choroideremia. The disease is caused by a genetic defect of the X-chromosome, which means that typically only males suffer the full effects. The research is in early-phase clinical trials

COVER STORY now, she says, and “early results are promising.” With a number of other targets in the laboratory, Bennett’s enthusiasm for her work never wanes. “It’s a very exciting time for the development of all these technologies.”

T CELLS TO THE RESCUE

Photo by Peggy Peterson

It’s not the typical thing on the to-do list of a 10-year-old, but in January, 2016, Emily Whitehead and her family donated $100,000 to the Children’s Hospital of Philadelphia. The money, raised by by the Emily Whitehead Foundation, was earmarked to support research by her physician, Stephan A. Grupp, M.D., Ph.D., a professor of Pediatrics in the Perelman School who heads the Cancer Immunotherapy Frontier Program and translational research for CHOP’s Center for Childhood Cancer Research. The hope is that the funds will help propel further progress in the field that made Emily a talisman for the many researchers and physicians who have devoted their careers to the pursuit of an effective cellular therapy for cancer. Her checkup that day also revealed that three and a half years after she became the first child to receive an experimental, personalized treatment that taught her immune system to fight her cancer, she was still free of the disease. Emily’s success and survival is the result of a lot of hard work over a long period of time. “It’s been a great collaboration,” says Carl H. June, M.D., a professor of Pathology and Laboratory Medicine and director of translational research in

the Abramson Cancer Center. He leads the Penn Medicine and CHOP research team that developed the treatment that saved the lives of Emily and dozens of other patients with several types of advanced blood cancers. Surveying the immense change in Emily’s life since she was near death at the time she entered the clinical trial in 2012, he observes, “To see a patient and the family come back and now be contributing to the treatment of other children – it can’t get better than that.” Emily was just five years old when she was diagnosed with acute lymphoblastic leukemia (ALL), which has an 85-to-90 percent cure rate with standard chemotherapy. But Emily relapsed in 2011, and her chances of survival dropped to 30 percent. Even with further therapy, she relapsed again the following year. Each time, her prognosis worsened. Later that year, as Emily got sicker and sicker and was running out of options, her mother found information about a clinical trial that had started at Penn Medicine. But Emily couldn’t participate in the trial yet – it was approved only for adults, with a different type of cancer. Again, FDA rules guided the strict process that would pave the way to testing the therapy in children. The timing wasn’t right – yet. At the time, only a small number of adults, all of whom had chronic lymphocytic leukemia (CLL) that had persisted despite multiple conventional treatments, had received the experimental therapy. The treatment used so-called CAR T cells. Carl June, who had been recruited to Penn a decade earlier, led the research.

Doug Olson was one of the first patients in the CAR T trial.

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Photo by Kari Whitehead

Emily Whitehead became the first child to fight cancer using Penn’s personalized cellular therapy.

David L. Porter, M.D., a professor of hematology-oncology and director of Blood and Marrow Transplantation in Penn’s Abramson Cancer Center, was in charge of the clinical trial in adults. Grupp was poised to lead the pediatric trial. They, too, had moved in similar orbits even before arriving at Penn. “David and I crossed paths before we came to Penn because he was at Brigham and Women’s Hospital and I was at Children’s Hospital in Boston,” says Grupp, who conducted some of the preclinical work that was necessary to bring the CAR T cell therapy into human trials. “I believe the best thing I did was to walk into Carl June’s office about 2000,” Grupp says. “It started a collaboration that was absolutely incredible Grupp and has gone on for 15 years.” He adds that June has been extremely committed to facilitating the pediatric work and making sure that what his group was developing in adults would apply to children as well. T cells are the body’s natural-born cancer-cell killers. The problem is, cancer cells often have cloaking devices that make them invisible to T cells. June and his team developed a way to help a patient’s immune system see the cancer cells and kill them. The process begins with removal of some of each patient’s T cells, through a procedure similar to dialysis. Inside HUP’s Clinical Cell and Vaccine Production Facility, led by Bruce L. Levine, Ph.D., a professor of Pathology and Laboratory Medicine, those cells are modified into so-called chimeric antigen receptors (CAR) cells. This engineering allows the new T cells to recognize a specific protein or antigen called CD19, which is expressed on the surface of cancerous B cells 14

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found in the blood cancers ALL and CLL. Once infused back into the patient, the reengineered cells hunt for cancer cells and attach to them like Velcro. A signaling domain built into each CAR T cell also prompts them to multiply and grow into 10,000 or more genetically modified cells in the body, expanding into a cancer-fighting army in the body as it does its work hunting for sick cells. Doug Olson, a patient in his 60s, was one of the first three adults to volunteer to try this new therapy in 2010. He became a pivotal part of a clinical experiment that would quickly expand to help patients two generations younger. He had been one of Porter’s patients and, for more than a decade, a series of drugs had kept his CLL in check. But the cancer was beginning to win. Porter believed he would be a good candidate for the clinical trial of the T cell therapy now known as CTL019. Olson entered the clinical trial at his sickest, without any FDA-approved options left. Entering the clinical trial, he says, was his last shot: “Quite honestly, I wasn’t thinking about moving science forward.” Instead, he was thinking about ways to live long enough until there was a cure for his disease. It’s something he firmly believes every cancer patient should be focused on – what’s right for me. June The treatment indeed worked, and Olson, a retired scientist himself, remains very grateful to be alive. “I’m five years past treatment. I still have these CART19 cells, and there’s no sign of cancer.” But would the treatment work for Emily? By early 2012, she was so sick and her cancer was growing so fast, she didn’t

COVER STORY Groundbreaking research can take a long time to reach the finish line, which June understands. He’s very optimistic about the future. In fact, he believes many more innovations will debut in Philly. The foresight and talent that has built upon the long-term collaboration between Penn and CHOP will continue to fuel innovative research. June calls it “CELLacon Valley,” a playful nod to Stanford University’s influence that led to Silicon Valley. One piece of evidence is Penn’s recent alliance with Novartis to construct the Center for Advanced Cellular Therapeutics on the Penn Medicine campus. The center, which is dedicated to the development, testing, and manufacturing of new types of CAR therapies, opened in February, funded in part through a $20 million investment from Novartis. Penn’s cell-therapy research has even caught the attention of Vice-President Joe Biden, who kicked off his cancer “moonshot” fact-finding tour at the Abramson Cancer Center earlier this year.

GIVING THE GIFT OF HANDS

In the fall of 2011, two months after a Penn Medicine surgical team had successfully completed its first bilateral hand transplant, many of the experts involved gathered on campus Photo by Peggy Peterson

even qualify for a risky bone-marrow transplant. Her father, Tom Whitehead, says she was within days of kidney failure and was offered hospice at the Hershey Medical Center, which had been treating her cancer. The family called CHOP again to see if there was anything they could do. This time around, the timing was perfect: a pediatric clinical trial had opened just the day before. CHOP’s institutional review board had approved the trial based on the strong early results seen in Olson and the other two participants in the adult clinical trial. So in April 2012, Emily became the first child to fight cancer using Penn’s personalized cellular therapy. The treatment was successful, but while her body was fighting her cancer, Emily got very sick with a condition known as cytokine release syndrome. She spent weeks in the ICU. Further Porter studies have shown that this side effect occurs in about a third of the patients, says Grupp, but at the time the researchers were not sure what was happening. Grupp, Porter, and June, along with other members of the team from CHOP and Penn, were in constant communication, trying to figure out how to treat her. In the end, Emily pulled through, after receiving a combination of drugs that have become standard therapy to treat patients who suffer severe side effects as the cancer-killing modified cells attack their tumors. The T cell therapy worked, and she has been in remission without further treatment for four years. Emily and her family started their foundation to help other children have access to groundbreaking treatments. Since her pioneering experience, the research team has reported results from 59 children – and 55 went into remission. According to Grupp, 79 percent of patients treated so far survived a year after treatment. Of those who remain in remission for a year, not a single patient has seen the cancer return. About twenty children are in this category. In addition to Olson, the first adult patient to receive the therapy, Bill Ludwig, a retired correctional officer, also remains healthy more than five and a half years after participating in the trial. According to the researchers, that is a tempting sign that the therapy may have real potential to last. Since Penn launched the CART-19 clinical trial (now CTL019), other institutions are conducting similar trials. Grupp notes, however, that there is a big difference. The patients elsewhere are often seeing the engineered T cells go away after about two months, or they receive the therapy as a bridge to undergo bone marrow transplants. Although it’s too early to say if these cancer-fighting cells will persist in patients forever, Doug Olson and Bill Ludwig still have them, and Emily Whitehead still has them. June is looking to the future when these CAR T cells will help fight other cancers. He expects that his team will make real progress in pancreatic and brain cancers over the next decade – “all because of this leukemia research.”

Lindsay Ess, the first bilateral hand transplant patient at Penn Med, has become a regular at the gym.

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to meet the local press. At one point, Abraham Shaked, M.D., Ph.D., director of the Penn Transplant Institute, was asked how he responded when L. Scott Levin, M.D., Penn’s chair of the Department of Orthopaedic Surgery, first suggested the incredibly intricate procedure. “I thought he was a little crazy,” Shaked said. But when he met the candidate for the first time, she gave him a hug, without arms. He felt Levin very moved. “You start to think about life in a different way,” he said. Levin, a native Philadelphian, came home to the city in 2009, after 27 years of experience in plastic and orthopaedic surgery at Duke University Medical Center. “From day one, I began working with CHOP,” he says. The process to transplant hands involves multiple tissues, including blood vessels, bone, nerves, muscles, tendons, and skin, and calls for specialized expertise from many types of surgeons. Levin began work right away with Shaked, and both were aware that hand transplants were not without controversy. They are not life-saving procedures, although they fundamentally improve quality of life. Nor are the procedures risk-free: just as in the case among patients who undergo organ transplants, the recipients of hand transplants must take immune-suppressing drugs for the rest of their lives to prevent rejection of their new hands. The risks of infection, diabetes, tumors, and premature death all rise. In 2010, the Penn Hand Transplant Program was launched. The new program – a collaboration between the Penn Transplant Institute, the Department of Orthopaedic Surgery, and HUP’s Division of Plastic Surgery – would perform only bilat-

At first, Abraham Shaked, director of the Penn Transplant Institute, was hesitant about the extremely intricate nature of a bilateral hand transplant. But when he met the candidate, she gave him a hug, without arms. He felt very moved. “You start to think about life in a different way,” he said. eral hand transplants. Levin and Shaked became the co-directors. In 2011, the transplant team was prepared. They already had a patient: Lindsay Ess, who followed Levin from Duke. She was the first patient to meet all the medical and psychological criteria for a hand transplant. At age 24, she developed 16

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a life-threatening infection that led to the amputation of her hands and feet. Once donor hands were located by The Gift of Life Program, the non-profit tissue and organ procurement program serving the Delaware Valley region, Levin and his team quickly set the operation in motion. The surgery, lasting more than 11 hours and involving 30 specialists, was a success. Levin and Benjamin Chang, M.D., an associate professor of clinical surgery at Penn, each headed a team that attached one of the donor hands. Lindsay Ess underwent an intensive, months-long regimen of physical therapy to train her to use her new hands. It was six months before she could control her fingers and thumbs, but important step allowed her to eat by herself. These days, she has mastered CrossFit, the strength and conditioning program (the version for people with disabilities), and is even lifting bar bells. If performing a bilateral hand transplant on a young adult might strike some people as a little crazy, imagine how they must feel about operating on a child! But according to Levin, Lindsay’s remarkable progress “gave us a foundation to adapt the intricate techChang niques and coordinated plans required to perform this type of complex procedure on a child.” Once again, he teamed with Chang, co-director of CHOP’s Hand Transplantation Program. Levin says the pediatric transplant world is not a large one, and eight-year-old Zion Harvey was referred to him by Scott Kozin, M.D., chief of staff at the Philadelphis Shriner’s Hospital for Children. The experience gained from Lindsay’s transplants taught Levin and Shaked – and all the other orthopaedic and plastic surgeons, nurses, psychologists, anesthesiologists, therapists, and social workers involved – valuable lessons in preparation for Zion’s surgery four short years later. Putting an adult on immune-suppressing drugs for a surgical procedure not meant to save a life was an ethical concern and a medical risk; with a child, it was an even more serious consideration. At the age of two, Zion had to have both hands and both legs below his knees amputated after developing a life-threatening infection. Just two years later, the sepsis damaged his kidneys to such an extent that he needed a kidney transplant, with an organ donated by his mother. That transplant, it turned out, helped pave the way for the first double hand transplant in a child. Because Zion was already taking immune-suppressing drugs after his kidney transplant, this ethical concern was moot, which helped convince the institutions to move ahead with the surgery. Another hurdle: Would this young boy have the psychological fortitude to cope with risk of the surgery, painful long hours of post-surgery physical therapy, and waking up every morning knowing he had another child’s hands? In his meetings with Zion, Levin was impressed by his maturity and by the obstacles he had already overcome. The Penn-CHOP team was ready; Zion was prepared. But when the operation could proceed depended on when donor

Left: Zion Harvey was 8 years old when he underwent the world’s first pediatric bilateral hand transplant.

Photo by Rob Press

Photo by Peggy Peterson

Below: Lindsay Ess has mastered the rowing machines.

hands might become available. That was contingent on the decisions of families in the midst of tragic losses – the death of a child. Levin notes that the donor pool is very limited; each year in the United States, only about 15 children become eligible. But the Gift of Life program and its counterparts across the nation find ways to approach prospective donor families at the worst times of their lives and guide them through the delicate process that allows their children to become organ and tissue donors. “The donor families – they are the real heroes,” Levin says. Last July, while visiting a friend in Montana, Levin got the call that donor hands had been found. He flew back immediately. That same night, he, Chang, Kozin, and about 40 other members of their team assembled at CHOP and began the operation that would give Zion new hands. It was a medical first: the world’s first pediatric bilateral hand transplant. For what is an already very delicate procedure, Zion’s team had to adjust tools and techniques to account for his smaller bones, blood vessels, and tissues – a critical component of the CHOP teams’ expertise. In the weeks following the procedure, the CHOP physical and occupational therapy team, along with Levin, noticed that Zion’s recovery was not advancing as they had hoped. The cause? His smaller brain. Unlike Lindsay,

who lost her hands later in life, Zion’s brain had never fully developed the sensation or power to control his hand muscles. Penn Medicine and CHOP clinicians assembled a team of neuroscientists to begin brain imaging and analysis to help with Zion’s mental and physical rehabilitation, adding yet another level of integration between the two programs. About Zion, Levin says, “I never heard a whimper from him,” even through six to eight hours of therapy each day. By six months after the groundbreaking surgery, Zion could hold a fork and write a letter to Santa, even arm wrestle with his surgeon and friend Dr. Levin. Aside from the transplant surgeries, Levin has fostered connections between Penn Med and CHOP in other ways. An attending surgeon at both CHOP and Penn, he has established a basic research program housed at both hospitals; fellows in hand surgery go back and forth between CHOP and Penn; and Levin has launched national and international education programs. The public got to meet Zion in the weeks following his story, as his case made news headlines around the world. Behind the little boy and his family is a belief and commitment to the power of possibility by the transplant team. It is, Levin says, “an exemplary program that has no boundaries and is fully integrated for a medical cause.” WINTER 2016

Although based at Dana-Farber/Boston Children’s Hospital, Venee Tubman, M.D., makes periodic visits to Liberia

Making a Difference By Lori L. Ferguson

On her returns to her family’s homeland, Venee Tubman has been instrumental in efforts to introduce newborn screening for sickle cell disease and to offer treatment for affected children.

enee Tubman, M.D. ’06, is a woman on the move. On the day we spoke, she was running to catch a plane, and in the early fall, she departed for one of the several annual visits she makes to Liberia, where her parents were born and where she now serves as a volunteer physician. As a pediatric hematologist/oncologist at the Cancer and Blood Disorders Center of Dana-Farber/Boston Children’s Hospital and an instructor of 18

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pediatrics at Harvard Medical School, Tubman is also in constant motion professionally. In addition to treating pediatric patients in the United States, she has made a firm commitment to changing the health-care landscape for children in Liberia. Her focus is chronic illnesses, particularly sickle cell disease (SCD), which disproportionately affects children in sub-Saharan Africa. There, survival for children in low- and middle-income countries from birth to age five is 10 to 50 percent, compared to 95 percent for children in this same demographic in high-income nations. One need only look at the statistics to understand Tubman’s sense of urgency and commitment. Today, in the State of Massachusetts (population 6.7 million), approximately 250 babies are born with SCD each year; in Liberia, with a population of 4 million, 1,500 babies are born each year with the disease. To compound the problem, when Tubman first returned to her parents’ homeland in 2008, there were only 50 practicing physicians serving a country of 4 million people. “Once there,” she says, “I realized that I had an incredible opportunity to explore global health and health care in a resource-limited environment and really make a difference.”

FEATURE Since that first trip in 2008, Tubman has dedicated herself to combatting the devastating impact of undiagnosed and untreated sickle cell disease in Liberia. She began her work in the capital city of Monrovia. Working as a consultant from Liberia’s national referral hospital, the John F. Kennedy Medical Center, Tubman has been collaborating with local practitioners and international partners to establish screening protocols for sickle cell disease in newborns and to create longterm treatment programs for those affected with the disease. Since launching the screening initiative in 2012, Tubman and her colleagues have screened 5,000 newborns and are providing continuing treatment for between 100 and 150 children. Within the next five years, her aim is to offer screening for 25 to 30 percent of infants born throughout the country – no small feat given that, at present, 40 percent of Liberian infants are not even born in a hospital. As she says unabashedly, “I’m a goal-oriented physician.”

The Impetus

Tubman’s passionate commitment to health care in Liberia is deeply entwined with her heritage. Her grandfather, William Tubman, was the country’s 19th president and its longest serving; he occupied the office from his election in 1944 until his death in 1971. Tubman was just an infant when her family fled the country for the U.S. following the military coup in April of 1980. It wasn’t until 2008 that it was safe for her to

in Liberia return. But despite the distance between Liberia and the northern Virginia suburbs where she was raised, Tubman says that she never felt far from her family’s roots. “There was a large expatriate community in the region,” she says, “so Liberian culture was a constant in my life as I was growing up.” There are no doctors or health-care providers of any kind in Tubman’s family, she says, but as a young girl she was captivated by science. “My family fostered that interest,” Tubman recalls, “and when I attended a magnet school in high school, my teachers offered further encouragement.” Tubman excelled at her studies and entered Harvard as an undergraduate, majoring in chemistry. It was here that her interest in hemoglobinopathies – a group of blood disorders and diseases that affect red blood cells, including sickle cell disease and thalassemia – was born. During an advanced chemistry course her senior year, Tubman became intrigued with the ways in which modifying hemoglobin would affect sickle cell disease. An inherited blood disorder that primarily affects children of African descent or Hispanic and Caribbean ancestry, it can also be found in those with Middle Eastern, Indian, Latin American, and Med-

SICKLE CELL DISEASE: A PRIMER Sickle Cell Disease is an inherited disorder of the blood that is associated with chronic and recurrent episodes of severe pain and severe anemia. Complications include stroke and increased risk of death because of infections during childhood; and in adults, renal failure, lung disease, and blindness.

SCD AFFECTS ABOUT 100,000 PATIENTS IN THE UNITED STATES.

250

1500

born in Massachusetts (population 6.7 million) each year with SCD:

born in Liberia (population 4 million) each year with SCD:

BABIES

• Symptoms begin in infancy and progress throughout life. • The clinical course is highly variable from person to person. • Amazing strides have been made to improve life expectancy for patients with SCD in the United States. The emphasis now is on preventing complications of the disease.

iterranean heritage. “I was fascinated to be in a space where I could consider the biochemical properties of this disease as well as its pathophysiology, which directly impacts the patient’s quality of life,” she says. “I found that combination very powerful.” Tubman’s fascination with sickle cell disease increased as she read about the challenges of the disease as well as the difficulties in managing it. “Sickle cell disease was initially described in 1949,” she notes, “yet over six decades later, we still haven’t made a great deal of progress in treating the disease.” The reasons for this delay are complicated, Tubman notes. The disease has been found to be much more complex than initially described and research into SCD is historically underfunded relative to the number of people afflicted. “I quickly realized that I had a real opportunity to work on a problem and have an impact.” The hook was set. After graduating from Harvard, Tubman entered Penn’s medical school, where she began to cultivate a complementary interest in global health care. Following her third year, she did a rotation on the Navajo Indian Reservation, then worked in Botswana with Stephen J. Gluckman, M.D., G.M.E. ’76, a professor of medicine, a specialist in infectious diseases, and medical director for Penn’s Global Medicine program. Tubman also spent time in Guatemala during her residency at Boston Children’s Hospital, learning Spanish and broadening her understanding of the issues in global health. “Global health experience was not widely available,” she observes, “and WINTER 2016

Above: Dr. Roseda Marshall, chair of Pediatrics, leads bedside rounds at John F. Kennedy Medical Center in Monrovia.

Penn was in the vanguard in allowing students to go abroad and gain this sort of experience.” The cumulative impact of these experiences heightened Tubman’s interest in providing medical care in Liberia. In 2006, following her graduation from medical school, she reached out to a family friend in Liberia and expressed her interest in working in the country. “He wrote back immediately and said, ‘Come – and don’t leave.’”

The Mission

And so Tubman went, travelling to Liberia for one month in 2008 as a volunteer physician. At the time, there were no fully trained pediatricians working in the entire country, so she found herself, as a junior resident, in the somewhat unnerving position of having more formal pediatrics training than any other practicing physician in the country. But she persevered, recognizing that the country’s pressing need for health care also afforded physicians and researchers great opportunity. “Sickle cell disease is highly heterogeneous,” Tubman points out, “so it’s very helpful to researchers to have such a large patient population to work with.” In the U.S., considerable progress has been made in extending life expectan20

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cies of those suffering from sickle cell disease – on average, adults live into their 50s and 60s. But in sub-Saharan African, life expectancies for those with SCD really only extend into the teens. “For a physician committed to improving the quantity as well as the quality of life, Africa is a good place to start,” Tubman says. “I realized I had a great opportunity to explore global health and health care in a resource-limited environment. Under such circumstances, we stand to learn a lot about the disease and as a result improve the quality of life for people with SCD the world over.” Although Tubman was enthusiastic about the task before her, she is also a realist. She knew that the newborn screening process would have to be broached carefully and in stages, due to the stigma and surfeit of misinformation surrounding the disease in Liberia. “A lot of families believe that there’s nothing they can do if their child has sickle cell disease,” she points out. “Some mothers are told that their children are only ‘half-children’ because they don’t live very long, while others are warned that a spirit occupies their child and will inhabit others in the family if given the opportunity. We have to combat these beliefs as well as the disease itself.” Tubman and her colleagues began with pre-test counseling of families, giving each mother they interviewed the choice of opting in for screening, rather than the opt-out choice offered to mothers in the United States. As a result of this thoughtful approach, Tubman says, more than 99 percent of the families solicited chose to be screened. “Most parents want to know if their child is affected with the disease and, if so, they want to start treatment.” By raising awareness of the disease, Tubman was able to secure the support she needed to launch her pilot screening program, an initiative that had not been possible in Liberia prior to 2012 because of a lack of tools for testing. The journey was not easy, Tubman concedes, but she was helped im-

FEATURE real problem in the country. Children afflicted with SCD typically die of anemia or pneumonia, which can be more severe because the children have the disease.” The results of Tubman’s initial study were compelling enough to persuade PerkinElmer, maker of one of the most common screening instruments used to diagnose SCD, to donate a machine for use in Liberia in April 2014. But then the Ebola crisis exploded. In August of that year, screening for SCD came to a halt. “Thankfully Ebola is now under control,” Tubman notes, “and the silver lining in that horrible outbreak is that there’s now a renewed focus on public health initiatives in Liberia and new logistical mechanisms in place that actually make our job easier.” Now, with a small lab being established in-country and hospital facilities set up to provide care for children diagnosed with SCD, Tubman is eager to resume screening. She admits, however, that identifying those afflicted with SCD is only half the battle. Her next challenge is actually a by-product of the initial screening process and the focus of her next study: treatment compliance. “We’ve successfully screened several thousand infants at this point and have identified between 100 and 150 kids with SCD that we’re treating.” But she reports seeing participation in the treatment program drop off around one year of age—something similar to what’s been witnessed by those running treatment programs for pediatric HIV patients.

Photo by Graham Perry/NCS

measurably by her friend and mentor Kwaku Ohene-Frempong, M.D., G.M.E. ’80. The Ghanaian-born physician and professor of pediatrics at The Children’s Hospital of Philadelphia and emeritus professor of pediatrics in the Perelman School, Ohene-Frempong is also the emeritus director of the Comprehensive Sickle Cell Center and president of the Sickle Cell Foundation of Ghana. One of the world’s foremost authorities on SCD, he is also himself a carrier. “Dr. Ohene-Frempong has been a huge supporter of my work,” Tubman says. When she was in medical school, she heard about his program in Ghana, which began more than 20 years ago. Working with Ohene-Frempong has taught her many things, she explains – the most valuable being the importance of persistence. “He’s helped me to see that if I have an idea of what I’d like to do, then I simply have to power through all of the challenges that arise. And I can tell you that working in global health, there are many!” Tubman leaned heavily on Ohene-Frempong’s experience and resources to get her fledgling project off the ground, obtaining samples from newborns in Monrovia and shipping them to the laboratory in Ghana that processes Ghanaian newborn samples. The results were then forwarded to Tubman in the U.S., where she reviewed them and then sent them back to Liberia. “It was a somewhat cumbersome process,” she concedes with a smile, “but we were able to accumulate enough samples to demonstrate that sickle cell disease was a

Venee Tubman consults with Megan Aitro, a clinical research coordinator at Boston Children’s Hospital, and others. WINTER 2016

Children and families from the Greater Monrovia area took part in a Sickle Cell Awareness March in September 2015.

The reasons for the drop in compliance are many and quite complicated, Tubman explains, and relate to factors as diverse as age, gender, distance to the clinic, perceived benefits of treatment, and religion. In the next phase of her study, Tubman hopes to interview all of the families of children diagnosed with SCD so far, to determine what factors are preventing them from returning to the clinic for treatment. “We’ve had a number of families who started off strong and then dropped off after about a year, as well as some families who have refused to return to the clinic for treatment at all,” Tubman notes. “Our aim is to identify the factors that make it difficult or undesirable to stay involved with the Chronic Care Clinic and also explore ways of expanding care into the community.”

The Future

Despite these setbacks, Tubman remains upbeat about the progress being made in Liberia’s pediatric health-care programs. Since making her first trip to Liberia eight years ago, Tubman has pushed hard to effect change in the country’s health-care system – not only in the diagnosis and treatment of sickle cell disease, but also in the delivery of health care in general. While the physician shortage in Liberia remains severe, the number of resident doctors is up from 50 to between 200 and 300. There is now a pediatric residency program in place as well. In addition, five full-time pediatricians have been recruited to work in Monrovia, and Tubman is in constant communication with a consortium of hospitals and physicians who send practitioners to Liberia regularly. These consortium physicians support physicians in Liberia by doing volunteer rotations and by offering on-site training to medical students and Liberian physicians. Each attending physician takes a two-to-four-week rotation. They also bring residents, who stay for four to eight weeks. Tubman calls it “a wonderful, bi-directional learning experience for both sides.” The goal for this outreach is not to cure sickle cell disease and other such illnesses in Liberia, Tubman is quick to point out. That’s simply not feasible. Instead, the aim is to build Liberia’s health-care system and increase the number of providers 22

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working in the country full time, because they will be the ones to have the longer impact. “I visit the country and see patients for two to three weeks at a time, and while that’s helpful, it won’t change anything long-term,” she says. “Instead, our goal is to train physicians there in best practices as we know them, modeling evidence-based, patient-centered care and helping them to refocus their practice. Those are the measures that will have an impact on Liberians.” As for her role in combating sickle cell disease and improving health care in Liberia in general, Tubman is realistic yet optimistic. “I remain a dedicated physician and scientist,” she says. “This work has been a huge blessing and it has given me amazing perspective. I’m truly passionate about delivering outstanding patient care and empowering people. I realize that I can’t change the fact of an inherited disease that someone is struggling with, but I can affect the impact it has on his or her life.” Tubman attributes her drive and determination in part to the many great mentors she has had throughout her life, from counselors in summer programs during high school and college to professors and colleagues who guided her in medical school and beyond. The education and the encouragement she received while in medical school at Penn also played a seminal role. “I got wonderful training while at Penn, and the school really worked with me to help me realize my potential and avail myself of every opportunity that came around.” Tubman is now paying that generosity forward, not only through her work abroad, but also by mentoring Harvard Medical School students and sharing her knowledge with the public at large through appearances on radio and television. Her efforts are not going unnoticed: last year, Tubman was awarded Boston Children’s Hospital’s 2015 Black Achiever Award, which annually recognizes two exceptional employees for their professional accomplishments and service to the community. “Many people have encouraged me to push myself and pursue my passions,” Tubman says. “They’ve helped me to see my potential, so now I want to do that for others.”

MYPENNMEDICINE: PENN’S PATIENT PORTAL

by Susan Perloff

Patients and providers increasingly agree that mPM is transforming health care. “Take two aspirin and e-mail me in the morning.” At the University of Pennsylvania Health System, patients with questions are encouraged to e-mail their health-care providers instead of phoning them. And the doctors e-mail back. It’s a technical revolution that all parties appreciate! Currently, about 240,000 people actively use myPennMedicine (mPM), the institution’s secure electronic portal that allows patients to submit questions, read test results, and request appointments online. Between December 2009 and April 2015, electronic messages to and from patients soared from zero to almost two million a month. That’s a lot of phone calls avoided and office paper saved. Patients and most providers like both the 24/7-ness of the electronic system and its directness, which make it the opposite of whispering down the lane. Any literate, clear-thinking patient can submit a clinical message without fear of distortion and expect an educated, medically sound response within a few days. An example of cloud computing, mPM allows doctors and their staffs to communicate with patients and their families in

a new, efficient way. It’s the health-care equivalent of ordering a pizza, a pillow, or a party dress from home. A patient can schedule a Pap smear, request a prescription renewal, or find the dates of upcoming appointments from a desktop, smartphone, or tablet. Susan C. Day, M.D. ’77, G.M.E. ’81, is a professor of clinical medicine, primary-care provider, director of population health for the Division of General and Internal Medicine, and associate chief medical information officer (CMIO) for the Penn Medicine’s patient portal and population health. According to Day, patients, especially younger ones, like the ability to stay up-to-date on health maintenance, refills, and easy referrals without unnecessary trips to the doctor’s office. They even like receiving test results, which sometimes arrive in an inbox without adequate explanation. That, too, is changing, with new access to the Healthwise online library, which explains and interprets lab tests. “We have just turned on the ability for patients to send in data on their weight, blood pressure, step count, and blood sugar by linking mobile devices, such as Apple Watch, scales, blood pressure cuffs, and glucometers, through the patient portal.” Day says this technology “should help us manage chronic conditions like diabetes and high blood pressure.” Penn’s electronic medical records (EMR), called PennChart, went live in 1998. The software comes from EPIC, a private company in Wisconsin that serves large medical groups, hosWINTER 2016

pitals, and integrated health-care organizations. Ten years later, the system first allowed patient interaction. Scott Schlegel, M.B.A., associate vice president for EMR integration at Penn, co-chairs the myPennMedicine efforts with Day. At present, mPM handles only ambulatory-care data within Penn’s EMR system. Schlegel notes that the service receives more than 500,000 messages each quarter. More than three-fourths of UPHS employees have accounts, plus 21,000 in the 13-to-17-year-old range, from such areas as family medicine, dermatology, and sports medicine. More than half the users are 50 or older, and, amazingly, 14 people over 100 – or their caretakers – have tried the Penn portal. Usage is accelerating rapidly. mPM flourishes at four Penn hospitals: HUP, Pennsylvania Hospital, Penn-Presbyterian Medical Center, and Chester County Hospital. “It transforms how we practice and how we do research,” Day says. “It has huge potential.”

“Your Mailbox Was Full”

myPennMedicine is a boon for practitioners. Neil R. Malhotra, M.D., G.M.E. ’09, assistant professor of neurosurgery at Penn and director of the Neurosurgery Quality Improvement Initiative, is an enthusiastic user. “When I remove a tumor from a patient’s brain, of course I want to be sure that the procedure goes smoothly,” he says. “But I also want to be sure that the patient understands what’s going on and is able to participate in their ongoing care. That’s one of the ways I use myPennMedicine.” Malhotra calls mPM “remarkable for patient empowerment.” As he sees it, “There’s no time for clinicians to spend time during a complex physical exam explaining every detail to a patient. But if my patients look at reports and lab tests online before they come in, we can have more constructive conversations. During a repeat visit, I can explain why their numbers matter.” With this system, he continues, “rather than leaving my office and forgetting what I said, they can now ask whether their potassium level could possibly relate to their cramps. They may not understand cell biology, but they are more empowered than

Patient Portals in Other Major Medical Centers

While the administration is justly proud of myPennMedicine, Penn is not alone among major medical centers in providing electronic communication between physicians and their patients. • •Yale’s “My Chart” system, which closely parallels mPM, allows patient-physician communication, prescription renewals, access to test results, and views of recent clinic visits. • •Johns Hopkins, which purchased the framework for its “My Chart” from Epic, went live in 2013. • •Mayo Clinic combines elements of the GE and Cerner patient portals with its own features. It also has a mobile app for Apple, Android, and Kindle platforms for its “Patient Online Services.” About 700,000 patients currently have online accounts. • •Harvard uses multiple electronic platforms for its multiple hospitals, private practices, and student health. 24

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without the online information. If you’re a little bit scared, you’re a little more likely to remember what we say on that topic.” Managing prescription refills no longer needs to occur face to face. “So mPM frees valuable time for us to focus together on their care,” he says. Michael A. Ashburn, M.D., M.P.H., M.B.A. ’05, professor of anesthesiology and critical care and director of the Penn Pain Medicine Center, also values mPM. “It allows me to look at a patient request and respond without having to track the patient by phone,” he says. “If it’s a simple request like a refill, I can send it to the pharmacy electronically, notify the patient, and close the loop in one interaction. It interferes less with my routine clinical practice.” When Ashburn phones patients, he says, “At least 30 percent of the time the patient doesn’t answer or there’s a bad connection or they have forgotten why they called. Then they want an appointment, and I have to refer them to someone else to schedule.” According to Ashburn, mPM allows physicians to respond more effectively and efficiently to half the inquiries. “That gives us more bandwidth to handle the calls that need to be made.” If a patient doesn’t present adequate information when querying online, Ashburn can request more: “If the message requires the participation of other team members, or prior authorization, or a myriad other scenarios, sometimes I can respond and route the message to others.” For a refill when Ashburn is unavailable, a staff member can authorize a partial supply and recommend a repeat visit to discuss the medication and/or dosage with the doctor. “And I have a paper trail,” Ashburn points out, “which is still important, not only for legal reasons, but also to resolve prior questions. Like a patient complains that no one called them back, and you look at the file and say, ‘I called you back on April 1, but your mailbox was full.’”

“Remember to Schedule Your Flu Shot”

Beyond direct doctor-patient messages, myPennMedicine reminds enrolled patients about appointments and inoculations. Not long ago, women had to remember to schedule their own mammograms. Now e-mails alert them. Sometimes watchful patient find errors in their own records. Two years ago, Penn Medicine’s senior leaders approved converting all clinical care and billing activity at all Penn Medicine locations to EPIC. Phase One, completed early in 2015, brought emergency care, transplantation, and radiology on board, says Schlegel. Part of Phase Two, which involves bringing inpatient clinical documentation, pharmacy, hospital billing, and home-care settings onto the single medical record, should be complete by October 2016. The rest is scheduled to be complete by March 2017. Ashburn acknowledges that mPM cannot serve every patient in every situation. Some people need to refill potent opioids, which is not possible via the patient portal. “Sometimes patients try to use mPM to address urgent issues, but the system is not prepared for that.” And although the portal posts clear warnings that it is not intended for emergency care, some patients still may expect rapid answers. “We respond

FEATURE

throughout the day, but no one is dedicated to responding all day long, so the patient may not receive an immediate answer.” For all its benefits, says Day, the patient portal raises issues about health and age disparities, computer access and literacy. It will never be possible to switch all patients or all discussions to the Web. “Initially this feels like extra work. We need to teach physicians and staff that answering e-mails is just as important and needs to be just as quick as a phone call – and that may mean that there’s different work, not more work.” Some providers and staff members are concerned that electronic communications might destroy the barriers that shield them from being overwhelmed by patient needs. And some points of resistance remain for physicians, such as: • •Informing patients about complicated test results, such as chest x-rays that suggest cardiomegaly (an enlarged heart, often resulting from high blood pressure or coronary artery disease). • •Coordinating one patient’s care across multiple practices. • •Staffing the mPM queries. Determining which staff person handles which questions. Day says that each hospital-based medical practice strives to be a “patient-centered home,” a new buzzword. As such, it coordinates and delivers care, and it shares health information, including by the most current technology. Patients might come in three or four times a year, she says, but between visits, lots of treatment and prevention efforts occur. myPennMedicine enables the interactions. Some national research praises online patient portals. A 2012 Kaiser Permanente study showed that patients with access to their online records used their health-care system more than people who opted out of a portal. Ted E. Palen, Ph.D., M.D., the study’s lead author, did note that portal participants might have been more concerned about their health than those who didn’t enroll, a situation that would account for some difference in usage. A 2015 literature review in the Journal of Medical Internet Research concluded that patient portals show significant improvements in how patients managed their chronic diseases (although “sociodemographic disparities exist for portal use”). In addition, such portals seem to offer great potential for higher quality care. As the Penn Med experience shows, the electronic system can also function as a way to conduct patient surveys. Ash-

burn’s office sends patients an after-visit summary with instructions for answering questions. “We are reasonably aggressive in collecting patient-outcome data, particularly how intense their pain is,” he says. “These answers are very important to us.” Schlegel expects that patient-reported outcomes will change as more people participate on mPM. Questionnaires and USB-enabled devices – such as glucometers, blood pressure cuffs, and scales – can directly download information into a portal that care teams can use. All this without a need for office visits or, indeed, any direct contact. Day and Schlegel are looking at ways to inform interested patients about participating in research studies that might be relevant to them. The Health Kit app on iPhones can link directly to Penn’s site, and additional software is developing. “The software and the interface can be intimidating” because it’s new, says Day. “There’s a learning curve for everyone.”

Improvements Ahead

No, myPennMedicine is not perfect. Patients have legitimate beefs, such as these: There can be a lot of variability in how quickly and how carefully offices deal with patient requests, says Day. One of her colleagues encouraged his mother to participate. The woman expressed frustration when she sent a message to her provider and received a “your message has been received and forwarded” auto response from the office – but there was no actual follow-up from her provider. She vowed never to use the system again. According to Ashburn, “My patients get frustrated when they use mPM and then are told they need to call to resolve the issue, or when it takes several messages to adequately resolve the issue. When a patient sends a message about a health issue that leads to the physician suggesting they come in, they then say, ‘O.K., please book me.’ My response is, ‘I don’t know how, please call. . . .’ And they have to call again or go back into mPM again. I certainly understand their annoyance.” An advisory committee, comprising patients and advocates, evaluates these types of issues and makes recommendations for improving the processes. Schlegel is looking ahead. “It took a long time for electronic communications to come to health care,” he says. Some medical centers put physicians’ notes on their electronic charts. But, he adds, doctors’ notes have traditionally remained behind the curtain. “We’re not pushing for that right now.” He sees the future of mPM as adding bill paying and enhancing functionality. Another possibility: visits via video. “It’s a rapidly evolving and exciting world,” Day says. “It engages the whole medical team – doctors, nurses, nurse practitioners, social workers, front desk, and, most importantly, patients – in designing better ways to access and deliver care. It’s not perfect, but it has a lot of potential. This is my soapbox.” And perhaps not far off: “Take two aspirin, sit in front of your computer screen, and say ‘Aaah.’” WINTER 2016

A Health Program

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FEATURE

A Penn Medicine center works to improve the health of highrisk patients by matching them with community workers who provide support and help them navigate the health system.

hen Randy Hastings, a senior community health worker at Penn Medicine, first went to meet Anthony Jones, he had some reservations. Looking over the last few years of his new client’s medical history, which included diabetes and heart problems, Hastings couldn’t help but wonder if Jones

Jones was on board immediately. He decided that he would tackle the exercise part of the plan from home, walking in his neighborhood. With the brutal cold of the previous winter finally receding, it was the perfect time to get outdoors. That decided, he then mentioned to Hastings that he needed help with the second part of the plan. “Because of his diabetes, he wanted to meet with a nutritionist to get a menu plan and a shopping list,” Hastings recalled. “So I made him an appointment that day with a diabetes nutritionist at the Perelman Center. He kept his appointment and got a low-calorie menu plan. He did a follow-up or two with the same nutritionist and also started walking, as promised.” The first meeting between community health worker Orson Brown and Patricia Quick didn’t go quite as smoothly. It was late in the day, and there were others with Quick at her primary-care doctor’s office. There wasn’t going to be time for the traditional one-on-one introductory interview. Still, Brown politely and respectfully introduced himself to everyone there, and let Quick know he’d be helping her meet her health goals. Most important, despite the limits of the interaction, Brown immediately made some observations that would be critical to their partnership in the months ahead. Hastings and Brown are part of the team at the Penn Center for Community Health Workers. The center uses the custommade IMPaCT model adopted by the University of Pennsylvania Health System to provide individualized, home-based, and community-based care to high-risk patients. (IMPaCT stands for “individualized management for patient-centered targets.”) The proBy Kevin Ferris gram is based on research begun in 2010 by Shreya Kangovi, M.D., G.M.E. ’10, M.S. ’13, aimed at determining and overcoming the barriers to better health for low-income patients. An assistant professor of medicine, Kangovi is the founding director of the center. By grounding their work in the experiences of patients themselves, the researchers learned that often the barriers are not necessarily medical — and are often beyond the ability of doctors to learn or fix in the course of an office visit. Sometimes the problems are as simple as being unable to get medication at a pharmacy or not having transportation to appointments. Housing and nutrition problems also can get in the way of maintaining good health. And it’s one thing for a health pro-

with IMPaCT was ready to tackle the challenges ahead. Community health workers are partners with their clients, clearing the path of whatever obstacles are keeping them from better health and recovery. But, ultimately, the client must be willing to take the necessary steps. “I have to admit, when I did his initial interview, and because of the fact that he had a couple of medical issues, I wondered if this was something he could handle and follow through with,” Hastings said recently. “But Anthony was ready. He was motivated from the beginning and easy to work with.” They met at the office of Jones’s primary-care doctor, where Jones and his physician had already discussed his weight-loss goals for the next six months. It was Hastings’s job, in the course of their initial 30-minute interview, to start outlining realistic steps toward achieving the goals. “I basically explained to him how this works, that we break it into smaller steps, something that’s manageable and comfortable for him,” Hastings said.

Photographs by Peggy Peterson

Randy Hastings helps Anthony Jones (with hat) make some food choices at Philadelphia’s Reading Terminal Market. WINTER 2016

had fallen short. As a result, community health workers are not out there on their own. They are on the ground working closely with patients but are in regular contact with supervisors and a team that offers expertise in both medical and social work – the better to tackle any barrier to better health. And Penn has been careful about whom it hired for these crucial positions. When the center was established in 2013, it had six full-time employees. Today, there are 24 community health workers, each with 140 hours of college-accredited training. This year, with more than $2 million in federal and philanthropic funding and support from Penn Medicine, they will provide navigation, social support, and advocacy for more than 1,500 high-risk patients.

fessional to urge more exercise, but for a patient, finding the motivation to take that first step can be daunting. Enter the community health worker, a bridge to a wide range of medical and social needs for clients who lack the skills and resources to navigate what can appear to be daunting medical or human services systems. One on one, the community health workers help patients set realistic goals, provide critical links to specialists or city and state agencies, and offer guidance and support along the way. The aim, after their sixmonth partnership, is for patients to have the skills and selfefficacy they need to continue on their path to better health. The concept isn’t new, but Penn Medicine’s approach is. In fact, the research included studying where similar programs 28

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The ideal candidates for these positions – again, based on asking patients what would help them most – come from the community. They’re the people who are already looking out for their neighbors, checking in on the sick, providing rides where needed, and offering guidance and emotional support during tough times. For example, Brown, who started with Penn Medicine last year, was already helping the sick and shut-ins as a member of Grace Christian Fellowship in Southwest Philadelphia. He and his wife don’t live in the city, but they wanted to worship where the need was greatest. When a Penn recruiter visited one Sunday, literally sitting right next to Brown before he was called on to address the congregation, it seemed like a sign. “For me, it was like breathing fresh air,” Brown said. “I had been looking for a career change, wanting something where I could make more of an impact on people’s lives, to help them. This sounded like the perfect fit.”

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They went to doctors’ appointments together. They toured the YMCA on 52nd Street, to see if workouts there could supplement Jones’s walks. And they took the El into Center City to shop at the Reading Terminal Market, with its wide array of fresh fruits and vegetables.

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Hastings inherited his community spirit from his mother, a longtime fixture in South Philadelphia, where he was born and raised. Long before he began his work with Penn in 2013, he and his mother were there, helping others. “The work I’m doing now isn’t much different from what I’m used to,” he said. “It’s what I’ve always done for my neighbors and my family and my friends, connect them with resources, discuss medical problems, and help with private issues.”

The games became a weekly event. She didn’t always win. But they did always talk. “We started to get a better understanding of each other,” Brown said. Jones stuck to his goals, short and long term. He would walk at least three times a week in his neighborhood, first in South Philly and later near his new home at 56th and Market. He’d head out first thing in the morning, sometimes combining the exercise with his day’s errands. Hastings joined him on one occasion. “I just stopped by because I was in the neighborhood and wanted to see how he was doing,” Hastings said. “We walked and we talked, about three blocks. He really got out there and got that done.” Jones’s pace is slow, but he is steady and determined. When alone, Hastings said, “he just puts the buds in his ears with his music and he just takes it all in stride. He’s a laid-back type of guy. He just doesn’t stress.” In the first month with a new client, Hastings tries for at least three in-person visits, but he was also calling Jones almost weekly to check on things like his blood sugar levels. “Anthony was easy to work with,” Hastings said. “I call and ask him about his numbers, and he would just get them. I’d ask if he wanted to participate in this or that, and he was always motivated to go.” They went to doctors’ appointments together. They toured the YMCA on 52nd Street, to see if workouts there could supplement Jones’s walks. And they took the El into Center City to shop at the Reading Terminal Market. Hastings thought it a perfect location for a diet-conscious person to take in a wide

Brown noticed two things in that all-too-brief meeting with Quick. First, how quiet she was. He would have to find some way to gain her trust, to get her to reveal more about herself. The second came from the way she shook his hand, even how she carried herself. He thought, she’s played ball somewhere. So when he followed up by phone the next day, a Friday, he asked. Turned out she hadn’t just played – she loved playing. She had been a three-sport athlete in high school. After shopping, Anthony Jones heads to the subway. Well, Brown continued, since her goal was to lose weight and exercise more, would she meet him on a basketball court Monday? “And she was right there with it,” he said. Although she was game, she wasn’t strong. She hadn’t been on a court in years. So the plan was to play to five and see how that went. And while they played, finally, they had that initial interview. “I used that time to just try to pry my way in a little bit as we’re playing,” Brown said. “Question here, question there, get a feel for who she is, what’s important to her, what she’s trying to work on.” Gradually, the quiet woman he met the week before started to talk. And, in the process, she beat him. “It was good because she felt good,” Brown said. “She enjoyed doing it, and I took pleasure in that, helping her do something she likes to do.”

WINTER 2016

Orson Brown built a relationship with Patricia Quick on the basketball court.

array of fresh fruits and vegetables. Jones patiently and steadily walked the crowded aisles with Hastings, black straw hat atop his head. After much careful deliberation, he found what he was looking for: mountain trout. He likes it fried. The games between Quick and Brown had gradually gotten longer. To ten points, then sixteen. By mid-August, they were ready to play to thirty-two, but you had to win by two bas-

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The ideal candidates for community health workers come from the community. They’re the people who are already looking out for their neighbors, checking in on the sick, providing rides where needed, and offering guidance and emotional support during tough times.

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kets. They met on the courts of the Francis Myers Recreation Center, where a mural proclaims, “I have seen that if you truly desire something better, it’s not as hard as you think.” At this point in their partnership, Quick was no longer weak. She jumped out to an early lead, at one point dribbling in and making a layup, going ahead 6-2. She dribbled the ball between her legs, made an easy hook shot, dominating as the score hit 14-2. Even with Brown towering over her at one point, she ducked around and made another basket. Brown 30

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started to push harder, getting himself back in the game, while regularly checking to make sure she was doing OK. She was more than fine. “All net,” she cried at one point, going further ahead to 2610. Then another from the outside, and one more from near the foul line. A commanding 30-10 lead. One more to win. And that’s when Brown started to come back. He had taken some good-natured teasing at the office after that first game – for losing to a girl – so even if he couldn’t always win, he would try to play respectably. But he also used the time to check in with Quick, to make sure she was doing all right – in between the moments spent trash-talking each other. On this day, by the time Brown tied the game at 30-30, Quick had slowed down. “I get tired,” she said. “You all right?” he asked more than once.

FEATURE

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By grounding their work in the experiences of patients themselves, the researchers learned that often the barriers to health care are not necessarily medical — and are often beyond the ability of doctors to learn or fix in the course of an office visit.

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Indeed she was, making one more basket from the foul line and then ending the game with a layup. They high-fived. “Way to compete,” Brown congratulated her. “Way to not give up, to keep on fighting.” The pair cooled down at a bench on the sidelines, but the work continued. Quick has been looking for a new home for her and her twin sister. The two abandoned houses on either side of her were attracting problems that created too many headaches for someone who was trying to stay on a healthier, stress-free track. So after the game, Brown set up his shop courtside. While she held the game ball, he had his phone out, a list of numbers in folder before him. He started making a series of calls about potential new places for Quick to live. “She needs to get out of that place and into better housing, and she needs help with that,” he said later. He didn’t consider it a distraction to his work with her but an important part of his mission. “Whatever the obstacle is that’s keeping her from achieving a health goal – well, I’m here to help her through that.” At one point, Jones had run out of his medications, something Hastings only learned about during their weekly check-in. It wasn’t an emergency situation, Hastings said, but he immediately set up a three-way call with Jones and his primary-care doctor. The prescription was called in to the local pharmacy, Jones picked it up, and he then checked in with Hastings to let him know that all was well. Hastings says he’s learned that just leaving such issues to the clients to resolve can sometimes mean unnecessary delays. “When I make a three-way call, I know it’s done and off their plate,” he said. “It’s something I work hard to teach patients: Do it now. I want it to become a new habit, something that will help them be self-sufficient.” He wants his clients to be ready to fend for themselves after their six-month partnerships end. In some cases, he’ll even quiz his clients about what just happened. “OK, we just did this,” he’ll say. “Now, what did we accomplish here? And what did we learn? What would you do the next time?” Not all of their encounters are quite so serious. During one in-person visit early in the relationship, Jones seemed upset. His disability check hadn’t arrived, he told Hastings. He didn’t know how he was going to pay his bills. Hastings immediately shifted into advocate mode. “I started

freaking out,” he said. “I said we were going to call this person and that person. I started to think that maybe it had just been mailed late, or might arrive later in the day.” In the middle of the freak-out, Jones said, “April Fool!” and started laughing. “When he did that,” Hastings said, “I knew the ice was broken for sure.” For his part, Jones said he suspects that he and Hastings will stay in touch after their six-month collaboration ends. “He really gets where I’m coming from,” Jones said. “He cares.” Quick had hoped to move by the end of August, but despite her efforts, and Brown’s, things weren’t working out as they’d hoped. Although frustrating, Brown says it’s important to remember that there are limits to what people can do, even with the best of intentions. “There’s no way you can have all the answers when dealing with other people’s problems,” he said. “You have to be mindful that it can weigh you down, to carry the weight of the world on your shoulders. I’m going to

During a post-game breather, Brown helped Quick find possible places to live.

work hard to find the answers, and I have good support – from supervisors and co-workers – to help me do that. But it’s tough when you’re going through that moment.” Fortunately, Quick and Brown have a common bond that helps them through such times. “One thing that makes it easier with Patricia is that we both have a belief in and a foundation of prayer,” he said. “Many times, if I’m not sure how to figure something out, I’ll say, ‘Let’s pray about it.’ It’s a good thing that we can come together in common purpose and pray, and it’s been a great thing in the relationship I have with her.” WINTER 2016

DEVELOPMENT MATTERS

Entering a New Decade of Discovery: ITMAT, IDOM, and CVI Just over 10 years ago, the Perelman School of Medicine – envisioning the potential of collaborative work across the School to benefit the health of patients with interrelated conditions – established three institutes with integrated missions. Today, the Institute for Translational Medicine and Therapeutics (ITMAT), the Institute for Diabetes, Obesity, and Metabolism (IDOM), and the Penn Cardiovascular Institute (CVI), all founded by former Perelman School dean Arthur H. Rubenstein, M.B.,B.Ch., have made measurable contributions to improving public health, further positioning Penn Medicine at the forefront of modern health care advances. “Dean Rubenstein demonstrated great foresight in creating these three biomedical institutes focused on integrating Penn Medicine’s research, clinical, and educational missions into an innovative care model,” said J. Larry Jameson, M.D., Ph.D., executive vice president for the Health System and dean of the Perelman School of Medicine. “ITMAT, IDOM, and CVI transcend the traditional bounds of academic disciplines and departments, encouraging increased collaboration and serving as a paradigm for other institutions.”

ITMAT: Leading the Charge from the Bench to the Bedside

The Institute for Translational Medicine and Therapeutics – the first institute of translational medicine in the world and replicated 100 times globally – is Penn Medicine’s signature scientific program. Its mission is to convert laboratory discoveries into new and safer therapies – with a special focus on partnering with The Children’s Hospital of Philadelphia to bridge pediatric and adult medicine for a lifetime of health for patients. ITMAT marshals the entire Philadelphia region in the pursuit of breakthrough medicine, including a core faculty of about 40 and more than 2,000 investigators from all Penn schools, CHOP, the Wistar Institute, the Monell Chemical Senses Center, and the University of the Sciences. ITMAT has

also successfully expanded the number of faculty capable of pursuing translational research and increased the quantity and quality of such work while also training more than 100 graduates with its master’s degree program in translational medicine. The strength of ITMAT’s approach – with more than 900 clinical trials and 31,000 visits annually – is evident in major breakthroughs emerging from Penn-CHOP collaborations in recent years. These include Dr. Carl June’s groundbreaking immunotherapy for leukemia as well as Penn’s Dr. Jean Bennett and CHOP’s Dr. Katherine High treating inherited forms of blindness. These discoveries have received significant media attention and revealed Philadelphia as a laboratory of innovation. “Over the last decade, we have helped to pave the way for new therapies for diseases and disorders that affect millions around the world,” said ITMAT director Garret FitzGerald, M.D., F.R.S., the McNeil Professor in Translational Medicine and Therapeutics and vice dean for translational science.

IDOM: Helping Patients Live Normal Lives

Sample storage at Penn Medicine’s BioBank run by ITMAT

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The mission of Penn’s Institute for Diabetes, Obesity, and Metabolism is to understand the genetic, biochemical, molecular, environmental, and behavioral origins of diabetes, obesity, and other metabolic diseases; reduce their incidence and severity; and translate its findings to the latest and best in patient care. In its first 10 years, IDOM has been one of the pre-eminent centers for diabetes and obesity research in the United States. It is one of only 16 diabetes research centers in the country funded by the National Institute of Diabetes and Digestive

ships, and unrestricted research funds – all essential to continued progress in cardiovascular services. The development of new treatments at Penn has been greatly assisted by the University’s focus on basic science – beyond gene sequencing, stem cell technology can now transform skin cells into cardiac muscle. “Big data” – the enormous data sets of electronic medical records compiled by the health system – allows Penn researchers to identify the complex patterns hidden in heart disease and other conditions and to develop treatments and cures.

Penn Medicine leadership gathers in the Smilow Center for Translational Research to celebrate IDOM’s 10th anniversary.

and Kidney Diseases, demonstrating Penn Medicine’s ability to raise awareness and interest in fundamental and clinical diabetes research – in Philadelphia and across the nation. “Diabetes, obesity, and other metabolic disorders are complicated and often have many contributing genetic and environmental factors,” said IDOM director Mitchell A. Lazar, M.D., Ph.D., the Sylvan H. Eisman Professor of Medicine and chief of the Division of Endocrinology, Diabetes, and Metabolism. “For example, for most people, there won’t be one gene that causes diabetes – there will be many, operating in pathways, interacting with environmental factors. People develop diabetes for different reasons. Our challenge is to identify and understand all those reasons and devise unique, individualized diets and treatment plans.” IDOM fosters collaboration across the university, uniting more than 100 Penn faculty members in multidisciplinary research teams. Together, they develop successful approaches and state-of-the-art therapeutic options for patients – from prevention to cure. Thanks in part to IDOM, Penn Medicine is recognized as one of the top medical institutions in the U.S. for diabetes research and care in U.S. News & World Report’s 2014-2015 “Best Hospitals” issue.

Penn CVI: Celebrating a Decade of Progress Fighting Heart Disease

The 10th anniversary of Penn’s Cardiovascular Institute – which boasts many of the nation’s leaders in fundamental cardiac biology, arrhythmia, and heart failure – was noted at a special “Penn Medicine Advances” at The Franklin Institute in November. CVI is home to nationally leading programs for many of the most complex cases, including heart transplant, cardiac electrophysiology, and complex aortic surgery. Aiding in the CVI’s achievements was the recent and highly successful Campaign for CVI, which exceeded its original goal and garnered $17.8 million, three new endowed professorships, five term fellow-

The Franklin Institute hosted this fall’s Penn Medicine Advances, during which the Penn CVI was lauded for 10 strong years.

“Penn created the CVI to pull researchers from across the entire university together in disease-focused, interdisciplinary studies,” said CVI Director Michael S. Parmacek, M.D., the Frank Wister Thomas Professor of Medicine and chair of the Department of Medicine. “Now, we’re seeing the fruits of this revolutionary idea as the CVI – as well as IDOM and ITMAT – make game-changing discoveries that translate into better patient care.” “Driven by collaboration and innovation, these institutes virtually embody Penn’s commitment to lead.”

Rubenstein Chair Established

As ITMAT, CVI, and IDOM celebrate 10 years of discovery, their founding dean has been honored with an endowed chair in his name. The Arthur H. Rubenstein, MBBCh, Professorship is the generous gift of Janet Haas, MD, and John Haas, as well as Anne and Jerome Fisher. “I am especially grateful to the Haases and Fishers for their generosity and vision in creating this chair,” said Dr. Rubenstein. “Endowed professorships play a critical role in academic medicine, providing essential support for recruiting and retaining the finest talent and giving them the resources to carry out innovative research.” WINTER 2016

PROGRESS NOTES Send your progress notes and photos to: Donor Relations Penn Medicine Development and Alumni Relations 3535 Market Street, Suite 750 Philadelphia, PA 19104-3309 PennMedicine@alumni.upenn.edu

1970s William H. Dietz Jr., M.D. ’70, G.M.E ’74, Ph.D., was appointed to the scientific advisory board of Weight Watchers International, Inc., to inform and advise the company as it continues to develop innovative offerings based on the latest scientific evidence. In 2014, Dietz joined the Milken Institute School of Public Health at the George Washington University as the director of the Sumner M. Redstone Global Center for Prevention and Wellness. The focus of the center is the search for solutions to obesity and other public health problems that are on the rise worldwide. A member of the National Academy of Medicine, Dietz is the editor of five books, including Clinical Obesity in Adults and Children and Nutrition: What Every Parent Needs to Know. David R. Snydman, M.D. ’72, received the 2015 Walter E. Stamm Mentor Award from the Infectious Diseases Society of America. He is chief of the Division of Geographic Medicine and Infectious Diseases at Tufts Medical Center, where he serves as the hospital epidemiologist and as an attending physician. As division chief, he was an innovator

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in developing a formal mentorship program in the late 1990s, modeled on a Ph.D. thesis committee structure, to provide more guidance to fellows as they progress through their training. In addition, for the past 10 years, Snydman has served as director of a successful grant program – funded by the National Institutes of Health – to train independent infectious diseases investigators in clinical research. An accomplished researcher with broad interests in trans-

Peter T. Pugliese, M.D. ’57, is the author of The Cookie Doctor: An American Physician’s Memoir of Life’s Obstacles and Miracles (The Topical Agent LLC, 2014). He spent two decades as a family practitioner in rural Bernville, Pa., where many of his patients were part of the Pennsylvania Dutch community. Since retiring from clinical practice in 1978, he became more involved in antiaging research and skin care. Author of Advanced Professional Skin Care and Physiology of the Skin (3rd edition, 2011), he is the founder of Circadia by Dr. Pugliese, maker of skin-care products, and has been honored with the Maison G. de Navarre Medal Award, presented by the Society of Cosmetic Chemists. The Cookie Doctor draws its name from the fact that Pugliese and other country doctors were often paid in commodities and received gifts of produce, meats, and sweets. But, as the author notes, that abundance was not always beneficial: “Obesity and diabetes were two diseases I had to battle constantly

plant-related infectious diseases, infection control, and clinical microbiology, Snydman has published more than 200 peer-reviewed articles and edited 20 books, including the third edition of Transplant Infections. For the past 16 years, he has been section editor of the Immunocompromised Host section of Clinical Infectious Diseases. Among his honors is the Distinguished Faculty Award from Tufts University School of Medicine.

Louis A. Matis, M.D. ’75, was named senior vice president and chief development officer of Pieris Pharmaceuticals, Inc., a biotechnology company. He brings to Pieris a successful background in developing novel biotherapeutics over a span of two decades. At Pieris, his work will advance therapeutic proteins based on its proprietary Anticalin® technology into and through clinical trials in anemia, asthma, and immuno-oncology.

in my patients. . . . At one farm, where I happened to be stuck in a snowdrift, the farmer invited me for breakfast before he pulled my car from the snow with his tractor. The breakfast consisted of fried eggs, fried potato, and sausage. This was followed by pancakes and scrapple, a butcher-scrap specialty whose ingredients are best left un-itemized. The mixture is ground up, formed into a loaf, dredged in flour, fried, and served covered with maple syrup. Finally, coffee was accompanied by coconut cake. I estimate that I had consumed close to three thousand calories that morning. No wonder I was facing an uphill battle against obesity in the Pennsylvania Dutch.” In his first chapter, Pugliese writes that his path to being a doctor “was by no means a direct route. After first setting out to be a priest, then a Marine during World War II, then a college student, then a soldier in the armored division during the Korean War, I became a premedical student and eventually a medical student. It was a long and arduous trip.” Along the way, he says, “I found God, lost him, and found him again. . . .” Bernville, where Pugliese lived in a stone farmhouse, is about 50 miles northwest of Philadelphia. It sounds like a wonderful place to raise a family, but as The Cookie Doctor points out, it was also a place where husbands sometimes abused their wives, incest was more common than Pugliese ever expected, postpartum depression sometimes rav-

aged families, and the doctor even had to deal with a woman who was convinced she was hexed by an unfriendly neighbor. Pugliese does not overlook his time as a medical student at Penn. He survives attending a high-pressure operation with I. S. Ravdin, then the celebrated chair of surgery, who would quiz the students, and learns a valuable lesson from Francis Wood, chairman of the Department of Medicine. Wood had a group of students examine the same patient, then suggest some diagnostic tests and a course of treatment. The patient was an 80-year-old woman who showed signs of cerebral insufficiency. Afterward, Wood heard their diagnostic procedures. “Most of us had suggested arteriograms, perhaps a pneumoencephalogram, and then one or two other arduous and painful tests.” Then Wood asked what they would do if the woman was their mother or grandmother. “Somewhat startled, we said that we would do none of those awful tests, but limit our test to the smallest number of painless procedures. . . . Dr. Wood said softly, ‘Do you not realize this lady is someone’s wife or mother or grandmother? As a physician, you must treat every patient as though that patient was your mother or your wife or sister or brother or father.’ . . . The class was dumbstruck. We had never heard this sentiment expressed by any other physician in the past three years. I recognized this advice was the single most important key to practicing good medicine.”

Josephine J. (Gargiulo) Templeton, M.D., G.M.E. ’75, who retired as senior clinical anesthesiologist at Children’s Hospital of Philadelphia, received the Special Achievement Award in Philanthropy from the National Italian American Foundation. Born in Capri, Italy, Templeton spent much of her early education in the United States but returned to Italy in 1961 to attend medical school. Upon her return to the United States for her postgraduate training at the Medical College of Virginia, she met her husband, John M. Templeton Jr., M.D. She did a residency in anesthesiology at HUP and a fellowship in pediatric anesthesiology and critical care at the Children’s Hospital. Templeton has been involved in numerous philanthropic and community activities. She serves as a trustee of The John Templeton Foundation, which her late husband served as president and chairman; the Museum of the American Revolution; and the scholarship foundation of the Union League of Philadelphia. Templeton was honored by the Salvation Army in 2005, and she and her husband received the 2006 Heroes of Liberty Award from the National Liberty Museum. Robert J. Laskowski, M.D. ’78, M.B.A. ’83, has been appointed chair of the board of directors of the Association of American Medical Colleges. A board-certified general internist with additional certification in geriatric medicine, Laskowski is a professor of clinical medicine at the Sidney Kimmel Medical College and a senior fellow at the Jefferson College of Population Health at Thomas Jefferson University. He has a wealth of past experience in leading both medical entities and medical education, including serving as president and chief executive officer of Christiana Care Health System in Wilmington, Del., from 2003 to 2014. Samuel O. Okpaku, M.D., Ph.D., G.M.E. ’78, reports that Essentials of Global Mental Health (Cambridge University Press), which he edited, received High Commendation at the British Medical Association 2015 Book Awards. A former fellow in

Junius John Gonzales, M.D. ’86, M.B.A., is serving as interim president of the University of North Carolina. Previously the senior vice president for academic affairs at the 17-campus system, he will serve as president until March 1, 2016. From 2011 to 2014, he was provost and vice president for academic affairs at the University of Texas at El Paso. He is a psychiatrist by training.

Penn’s Depression Research Unit and a former faculty member of Penn’s Department of Psychiatry, Okpaku is executive director of the Center for Health, Culture, and Society in Nashville. He has served as chairman of the Department of Psychiatry at Meharry Medical College. Jennifer Chu, M.D., G.M.E. ’79, who retired from Penn Medicine as associate professor of physical medicine and rehabilitation, is CEO and founder of eToims® Medical Technology, LLC. She is the first author of a study published this year in BMJ Case Reports, describing chronic refractory myofascial pain (CRMP) as a global public health disease. The study underscores the authors’ previous findings that electrical twitch-obtaining intramuscular stimulation (eToims) is safe and efficacious for long-term use in CRMP.

1980s Roy M. Kulick, M.D. ’81, G.M.E. ’85, has been named clinical development advisor of M Pharmaceutical, Inc., a clinical-stage company developing innovative technologies for monitoring and treating obesity, diabetes, and other gastroenterological indications. Kulick will prepare clinical trial plans for the company’s lead product, Trimeo, a weight-loss capsule. Donald W. Rucker, M.D. ’81, was appointed chief medical officer of Premise Health, a worksite health and patient-engagement company. A pioneer in medical information and technology, Rucker earlier served as chief operating officer of the IDEA Studio at the Wexner Medical Center of Ohio State University, where he was also clinical professor of emergency medicine and biomedical informatics. In his new role, Rucker will lead Premise Health’s clinical teams and share his expertise in biomedical informatics and data analytics. Reynold A. Panettieri Jr., M.D. ’83, G.M.E. ’90, who had been the Robert L. Mayock and David A. Cooper Professor of Pulmo-

nary Medicine at the University of Pennsylvania, has joined Rutgers Biomedical and Health Sciences. He is the inaugural director of what will be a new clinical and translational science institute. A pulmonologist, immunologist, and translational researcher, Panettieri has studied the cellular and molecular mechanisms that regulate airway smooth muscle cell growth and the immunobiology of airway smooth muscle. He has also directed the comprehensive clinical program for the care of patients with asthma and is actively involved in clinical investigations focused on the management of asthma and COPD. At Penn Medicine, Panettieri’s positions included chief of the asthma section for the pulmonary, allergy and critical care division and deputy director of the Center of Excellence in Environmental Toxicology. At Rutgers, he will lead all clinical and translational research initiatives across RBHS and lead initiatives to expand independent clinical research funding. Paul E. Jarris, M.D. ’84, has been named senior vice president of maternal and child health program impact and deputy medical officer at the March of Dimes. Jarris, an expert in health-care policy, clinical quality initiatives, disease prevention, and wellness, will lead the new department and will have overall responsibility for its prematurity campaign. Formerly, he was executive director of the Association of State and Territorial Health Officials. Susan L. Williams, M.D., G.M.E. ’84, was appointed chief medical officer for Conemaugh Health System, of Duke LifePoint Healthcare. She will lead Conemaugh in enhancing quality and expanding its physician network.

Victoria Tishman Handa, M.D. ’86, was named director of the Department of Gynecology and Obstetrics at Johns Hopkins Bayview Medical Center and deputy director of gynecology and obstetrics at the Johns Hopkins University School of Medicine. She and her research team at the university’s Women’s Center for Pelvic Health specialize in women’s health research, epidemiology, and pelvic floor disorders. Handa is a reconstructive surgeon and author of more than 100 scientific papers.

1990s Stephen Joseph Pakola, M.D. ’94, G.M.E. ’98, has joined Aerpio Therapeutics, Inc., as its first chief medical officer. Previously, at ThromboGenics, he invented and developed its lead product, Jetrea, from its inception through the FDA’s Biologics License Application process. At Aerpio, he will lead the advancement of the company’s development pipeline, including its lead therapeutic candidate, AKB-9778, for the treatment of diabetic macular edema. Santosh Kesari, Ph.D. ’96, M.D. ’99, was appointed to the scientific advisory board of Therapeutics Solutions International, Inc., and to the advisory board of GenSpera, Inc., a biotech company that develops innovative pro-drug therapeutics for the treatment of cancer. Kesari is currently professor of neurosciences and chair of neuro-oncology and neurotherapeutics at the John Wayne Cancer Institute at Providence St. John’s Health Center in Santa Monica, Calif. His research investigates the biology of gliomas with the aim of WINTER 2016

OBITUARIES developing new therapeutics for patients with brain tumors. Kevin G. M. Volpp, M.D. ’96, Ph.D. ’98, has been named lead advisor for patient engagement for the recently launched NEJM Catalyst. The online resource connects health-care executives, clinical leaders, and clinicians with practical approaches to improve the value of health-care delivery and patient care. Volpp is director of the Center for Health Initiatives and Behavioral Economics and a professor of medicine, medical ethics and health policy, and health management at the University of Pennsylvania.

waukee Foundation with a $200,000 grant through its Shaw Scientist Program. The annual award supports emerging investigators with innovative ideas in biochemistry, biological sciences, and cancer research. The goal of Wolman’s research is to understand how genes function to allow the brain to learn. His team recently identified a set of genes used by the brain to encode for a simple form of learning called

2000s Nishan de Silva, M.D. ’00, M.B.A. ’00, president and chief operating officer of Poseida Therapeutics, Inc., was appointed to its board of directors. He previously served on the boards of three public companies and several private companies. Poseida is a biotechnology company that uses gene editing technologies to develop life-saving therapies, including gene therapy for orphan liver diseases and immune-oncology therapeutics for several types of cancer. Jason S. Chinitz, M.D. ’07, has joined the cardiology team at Southside Hospital in Bay Shore, N.Y. He is board certified in cardiovascular disease and internal medicine.

2010s Rachel Anolik, M.D. ’11, who completed her medical training at Boston University, was appointed assistant professor of dermatology at Temple University’s School of Medicine and director of medical dermatology and inpatient service at Temple University Hospital and Fox Chase Cancer Center. Marc A. Wolman, Ph.D., G.M.E. ’15, assistant professor of zoology at the University of Wisconsin, was honored by the Greater Mil-

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habituation and noted that any disruption in the function of these genes leads to learning impairment. With his award, he plans to explore how one of these genes affects neuronal connections to promote learning. Wolman was a postdoctoral fellow in the laboratory of Michael Granato, Ph.D., a professor of cell and developmental biology at Penn Medicine. Wolman was first author and Granato senior author on a research paper published last year in Neuron. The team described the first set of genes important in learning in a zebrafish model.

OBITUARIES

1940s Alice Robinson Erb, M.D. ’40, Lanesboro, Mass., a retired physician; August 18, 2014. She served as clerk of Lehigh Valley Friends Meeting (Quakers), a board member of the American Friends Service Committee, a Girl Scout council treasurer and troop leader, a founder of the Allentown League of Women Voters, and a board member of Allentown Planned Parenthood.

Kenneth M. Scott, M.D. ’41, G.M. ’47, Black Mountain, N.C., a retired physician for the state Department of Public Health; September 15, 2014. He was born in Tsingtao, in the German Crown Colony, a son of Presbyterian missionaries in China. After serving in the U.S. Army during World War II, he was director and chief surgeon at the Presbyterian Hospital in Taegu, Korea, and later professor of surgery at Severance Hospital in Seoul. He and his family moved to Punjab, India, where Scott served as director of the Christian Medical College and Hospital. It comprised an 800-bed hospital, a medical college of 350 students, a nursing school, and several subsidiary hospitals. The Scotts returned to western North Carolina in 1974, and he worked at the Black Mountain Center as a physician in North Carolina’s tuberculosis program. Swithin Chandler Jr., M.D. ’43, G.M. ’55, Salt Lake City, a retired medical examiner for the Federal Aviation Administration; November 11, 2014. During World War II, he served in the 3rd Army with General Patton. He was with the 125th evacuation hospital and was a forensic pathologist and traveled throughout Austria, Belgium, France, Germany, and Holland. Wounded and awarded the Purple Heart, he was honorably discharged as a captain. After returning to the United States he practiced medicine in Trenton, N.J., Capistrano Beach, Calif., and Phoenix, Ariz., and settled in Salt Lake City. As an FAA examiner, he served many pilots in the intermountain area. Chandler received his pilot’s license in 1932 at the age of 17. He accumulated 6,210 hours of flight time and flew a variety of aircraft. Howard N. Douds, M.D. ’43, Upper St. Clair, Pa.; November 7, 2014. During World War II, he served in the U.S. Army Medical Corps. He was an internist in Mt. Lebanon and on staff at St. Clair Hospital from 1954 until his retirement in 2008. Robert K. Moxon, M.D. ’43, G.M. ’48, West Columbia, S.C., a retired physician; January 28, 2015. In World War II, he was

assigned to a beachmaster unit with Amphibious Forces during the invasion of Okinawa. He served as the ship’s doctor on the U.S.S. Piedmont during the occupation of Japan. Later in his Navy career, he was chief of medical services at the Naval hospitals in Annapolis, Md., and Portsmouth, Va. Retiring from the Navy with the rank of captain in 1963, he became director of medical education at Columbia Hospital. After retiring from an internal medicine practice, he served as consultant in internal medicine for Medicare utilization in the South Carolina Professional Review Organization, as an expert witness for Social Security Disability, and taught health topics at the Shepherd’s Center of Columbia, where he was a member of its board of directors. Thomas J. Nauss, M.D. ’44, G.M. ’49, Dallas, Pa., a retired plastic surgeon; December 18, 2014. During World War II, he served in the U.S. Army. Ashton T. Stewart, M.D. ’44, Quarryville, Pa., former chief of rehabilitation medicine at the VA hospital in Martinsburg, W.Va.; November 30, 2014. During World War II, he was a captain in the U.S. Army. In 1947, Ashton went to Iran as a medical missionary and served as the director of three different mission hospitals. For four years, he served in Afghanistan with International Afghan Mission, an international Christian organization. During the 1980s he opened a physical therapy school. Alfred H. Magness, M.D. ’45, Coshocton, Ohio; January 20, 2014. He completed his general surgical training at Ohio State University Hospital and Youngstown Hospital Association and was the first Coshocton physician to be certified by a specialty board, the American Board of Surgery. A Fellow of both the American College of Surgeons and the International College of Surgeons, Magness had served as chief of staff and chief of surgery at Coshocton Hospital for many years. He was especially proud that all four of his children became physicians.

William M. Groton, M.D. ’47, Sherborn, Mass., a retired physician with the state’s Department of Public Health; January 28, 2015. R. David Warner, M.D. ’49, Xenia, Ohio, a retired primary physician for the Ohio Soldiers and Sailors Orphanage Home; December 27, 2014. He served in the U.S. Army during World War II and the Korean War. He practiced medicine for 52 years, doing physicals for sports at many area schools, making house calls at all hours of the night, and delivering 4,000 babies.

1950s George R. Kennedy Jr., M.D., G.M. ’50, Tulsa, Okla., a retired physician; November 6, 2014. He served in the U.S. Air Force as a captain, first as chief of surgery at Webb Air Force Base in Big Spring, Tex., and then as chief of surgery at the 36th Tactical Air Group in Bitburg, Germany. Back in the United States, he established a medical practice in Bartlesville, Okla., where he practiced medicine and surgery for more than 30 years. He had been a Fellow of the American College of Surgeons and of the International College of Surgeons. William Plummer III, M.D. ’50, G.M. ’54, West Chester, Pa., a retired physician; June 15, 2014. He was a former member of Chester County Hospital’s section on endocrinology and metabolism and helped establish the first diabetic department there. Cliff Ratliff Jr., M.D., G.M. ’50, Ellicott City, Md., retired director of nuclear medicine at St. Agnes Hospital, from 1956 to 1990; January 28, 2015. William J. Tuddenham, M.D ’50, G.M. ’56, Naples, Fla., emeritus professor of radiology and a former director of radiology at Pennsylvania Hospital; October 5, 2014. He was founding editor of the journal Radiographics. During World War II, he served in the U.S. Naval Reserves. He was a recipient of the Gold Medal of the Radiological Society of North America.

Robert S. Ayerle, M.D. ’51, Paoli, Pa., a retired medical director in industrial and occupational medicine; November 6, 2014. After several years of employment as a research chemist with the Rohm & Haas Company, he left to pursue his true passion in medicine at the University of Pennsylvania. He completed his residency at Walter Reed Army Medical Hospital in Washington, D.C. After discharge from the military, he began his career in industrial and occupational medicine with the Pennsylvania Railroad Co. He then became medical director of Pennsylvania Bell Telephone Company, where he administered its medical departments that served 60,000 employees. While at Bell he oversaw a number of clinical research projects, including an early breast cancer screening study. Upon retiring from Bell, he became the international medical director for the Scott Paper Company. Ayerle instituted one of the first corporate drug and alcohol treatment programs in the country, helping thousands of employees and individuals gain sobriety and lead productive lives. He also served on the President’s Council for Alcoholism and the President’s Council for Physical Fitness. Capt. John R. Bierley, M.D., G.M. ’52, Winlock, Wash., a retired surgeon and medical officer in the U.S. Navy; August 23, 2013. He received a Purple Heart during World War II. As a civilian, he was a general surgeon and/or hospital medical director in Puerto Rico most of the years between 1935 and 1950. A Fellow of the American College of Surgeons, he also became a Diplomate of the American Board General Surgery in 1954 while in the Navy. Upon retiring from the Navy in 1970, Bierley was awarded the Joint Services Commendation Medal. Won Y. Koh, M.D., G.M. ’52, Bound Brook, N.J., a retired physician at Somerset Medical Center; November 21, 2014. He earned his medical degree at Yonsei University in South Korea.

James B. Aycock, M.D., G.M. ’53, Sparta, N.C., a retired radiologist; January 23, 2015. Thomas G. Dickinson, M.D., G.M. ’53, Sarasota, Fla., a retired ophthalmologist who had maintained a practice for many years; October 20, 2014. During World War II, he served in the U.S. Navy. Gordon D. Myers, M.D., G.M. ’54, Mechanicsburg, Pa., a retired surgeon who had served as a primary physician for the old Pennsylvania Railroad and several motor freight companies; January 27, 2015. He joined the U.S. Air Force during the Korean War and served as chief of surgery at the Dow Air Force Base Hospital in Bangor, Me., and was a captain at the time of discharge. Myers opened his own surgical office in Harrisburg in 1957. In 1965, he became the first director of the emergency department at Harrisburg Hospital. He was a Fellow of the American College of Surgeons, and the Harrisburg Hospital house physicians twice honored him with the Distinguished Teacher Award. Donald M. Cohen, M.D. ’56, Fort Worth, Tex., a retired pathologist; December 2, 2014. He was commissioned a lieutenant in the U.S. Army Medical Corps upon graduation. After his Army service, completed in Germany, he took his residency in pathology at the Mayo Clinic in Rochester, Minn. He practiced 37 years with Pathology Associates at Harris Hospital and another 10 years for ProPath Laboratories. Avery R. Harrington, M.D. ’56, Brunswick, Maine, a retired nephrologist at Maine General Medical Center; July 10, 2014. After earning his medical degree, Harrington and his wife, Carolyn, spent time on Indian reservations in Arizona. He later had a faculty position at the University of Wisconsin Medical School. The Harringtons volunteered for a year at rural hospitals in Zimbabwe, where they returned three times. John S. Strauss, M.D., G.M. ’56, Iowa City, emeritus professor of dermatology at the University of Iowa; July 28, 2014.

Marilyn Hess, Ph.D. ’57, M.S.Ed. ’85, emeritus professor of pharmacology; October 20, 2015. After earning her B.S. degree in chemistry and biology from Villa Maria College, she studied at Penn, earning her master’s degree in physiological chemistry and physiology in 1949. Her Ph.D. degree in pharmacology was the first granted at Penn. From 1946 to 1950, Hess was a research assistant at Penn. She joined the faculty in 1951 as an assistant instructor in physiology and, later that year, in pharmacology. She left her post in physiology in 1952 and rose through the ranks in pharmacology, eventually becoming full professor in 1976. That same year, she became the course coordinator for the Pharmacology Graduate Group and later became the course director of Pharmacology 100. Garret A. FitzGerald, M.D., the Robert L. McNeil Jr. Professor in Translational Medicine and Therapeutics, has described Hess’s Pharmacology 100 “the best inte-

grated course on pharmacology for medical and graduate students developed at any university in the country. Students taking her course consistently outperformed in this discipline in national standardized tests.” Hess served a year as acting chair of the Department of Pharmacology and served on the University’s Faculty Senate. She received the University’s Lindback Award for Distinguished Teaching and the School of Medicine’s Special Dean’s Award. Hess pursued her research on the relationship between perturbed metabolism and cardiac function. She obtained a presti-

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OBITUARIES gious Research Career Development Award from the NIH and became an Established Investigator of the American Heart Association (AHA). Hess retired from Penn in 1994. “It is as a teacher supreme that Marilyn will be most fondly remembered,” said FitzGerald. Bernard A. Kirshbaum, M.D., G.M. ’57, Bala Cynwyd, Pa., a retired dermatologist; September 14, 2014.

1960s William Preston Calvert, M.D. ’60, Marathon, Fla., a retired radiologist; January 26, 2014. His residency in internal medicine at the Pennsylvania Hospital was interrupted by the Vietnam War, and he served as a flight surgeon at Clark Air Force Base in the Philippines for two years. When his military service was completed, he returned to complete his residency as chief resident. He went on to the University of Miami, where he completed a fellowship in G.I. medicine, finished a residency in radiology, and became board-certified in radiology and nuclear medicine. During his time in South Florida, he served intervals as chief of radiology at local hospitals and spent time on the faculty of the University of Miami School of Medicine. William Pinsky, M.D. ’61, Lansdale, Pa., a retired physician who had maintained a practice there for 38 years; November 6, 2014. As a Penn undergraduate, he was a member of the men’s baseball team. Paul A. Urffer, M.D. ’61, Doylestown, Pa., a retired physician; December 22, 2014. He had been a radiologist at the Abington Memorial Hospital for more than 30 years. A veteran of the U.S. Army, he served during the Vietnam War. Arno R. Hohn, M.D., G.M. ’62, Pomona, Calif., retired professor of pediatrics at the University of Southern California; March 21, 2014. After serving in the U.S. Air Force, he became a faculty 38

PENN MEDICINE

member at Buffalo’s Children’s Hospital and then at the Medical University of South Carolina. He next served as chief of the Division of Cardiology at Children’s Hospital Los Angeles from 1984 through 1999. His research focused on hypertension in pediatrics as well as heart problems in muscular dystrophy, HIV, and premature infants. Hohn was editor of Basic Pediatric Electrocardiography (1974). Leslie P. Surrey, M.D., G.M. ’62, Philadelphia, a retired physician; November 3, 2014. He earned his M.D. degree from Howard University Medical School, then did his internship at Episcopal Hospital. While working at Germantown Hospital, he opened his own private practice and worked part time for The International Ladies’ Garment Workers’ Union. Arthur Ames, M.D. ’63, Storm Lake, Iowa; September 30, 2014. He overcame setbacks at an early age. Born with a club foot, he underwent more than a dozen operations to walk normally and at 16 contracted polio. After his specialty training, he was drafted into the Air Force and stationed as a surgeon at Ellsworth Air Force Base in South Dakota. Later, he started a family practice, eventually joining Buena Vista Clinic, where he remained until retiring in 1996. A. Stephen Boyer, M.D. ’64, G.M. ’71, Franktown, Va., a retired physician; October 11, 2014. Deborah M. Forrester, M.D. ’64, Malibu, Calif., an associate professor of clinical radiology, medicine, and orthopaedic surgery at the University of Southern California, where she was di-

rector of its radiology residency program from 1979 to 2003; January 17, 2015. She won several teaching honors, including the Lifetime Achievement Award for Excellence in Teaching in 1999. Forrester was first author of The Radiology of Joint Disease, a standard textbook in musculoskeletal radiology with three editions in the 1970s, 1980s, and 1990s, and she contributed chapters to 20 textbooks in the fields of radiology, orthopaedic surgery, rheumatology, and neurosurgery. Ralph G. Fennell, M.D. ’65, Parker, Colo., a retired flight surgeon; September 3, 2014. He completed a residency in aerospace medicine at Ohio State University, where he also earned an M.S. degree in preventive medicine. He joined United Airlines, where he was employed in a variety of locations over 30 years. Fennell was also a senior aviation medical examiner for the Federal Aviation Administration. A former president of the Airline Medical Directors Association, he was a Fellow of the International academy of Aviation and Space Medicine. Hazel I. Holst, M.D., G.M. ’66, Swarthmore, Pa., an emeritus associate professor of surgery at the University; April 9, 2015. An alumna of the Women’s Medical College of Pennsylvania, she had also worked at the Philadelphia VA Hospital and the Children’s Hospital of Philadelphia. Her specialty became hand surgery and use of the microscope in the repair of the hand. Holst was the first woman member of the Plastic Surgery Research Council and the Philadelphia Academy of Surgery. William E. Jacobs, M.D. ’69, G.M. ’76, Charlotte, N.C., a retired plastic surgeon; December 6, 2014.

1970s Arthur J. Kennel, M.D., G.M. ’70, Rochester, Minn., retired assistant professor of cardiology and chair of community medicine at the Mayo Medical School; December 12, 2014. From 1970 to

1972, he served with Medical Assistance Programs International by moving his family to Kinshasa, Zaire, where he became chair of the cardiology department at the 1,500-bed Hospital Mama Yemo (now Kinshasa General Hospital). He was a Fellow of the American College of Cardiology and of the American College of Chest Physicians. He published a memoir, Life, Love, Llamas, and Laughs: My Story, in 2011. Earl L. Giller, M.D., Ph.D., G.M. ’72, Madison, Conn., April 28, 2014. Giller earned his M.D./ Ph.D. degrees in neurochemistry from New York University, working in the laboratory of Eric Kandel, the future Nobel Prize winner. His career was dedicated to scientific advances in pharmaceutical development, and he taught numerous medical students at Yale University and at the University of Connecticut. He also worked for Pfizer for many years.

FACULTY Marilyn Hess, Ph.D. See Class of 1957. Hazel I. Holst. See Class of 1966. John M. Templeton Jr., M.D., Bryn Mawr, Pa., a former pediatric surgeon who was president and chairman of the John Templeton Foundation; May 16, 2015. After earning his M.D. degree from Harvard Medical School, he trained in pediatric surgery under C. Everett Koop, M.D., at The Children’s Hospital of Philadelphia. He served two years in the U.S. Navy, then returned in 1977 to Children’s Hospital, where he became director of the trauma center. He also taught at Penn’s School of Medicine. During his practice, Templeton became an expert in surgeries involving conjoined twins. Many of those surgeries were undertaken with his wife, Josephine Gargiulo Templeton, M.D., G.M.E. ’75, as lead anesthesiologist. A Fellow of the American College of Surgeons, he had also been vice chairman of the American Trauma Society and was president of its Pennsylvania division.

LEGACY GIVING

Richard A. “Buz” Cooper, M.D., New York City, former chief of hematology in the Department of Medicine and a pioneering cancer research scientist; January 15, 2016. He wrote the grant proposal to create what would become the University of Pennsylvania Cancer Center (now the Abramson Cancer Center) and served as its director from 1977 to 1985. Cooper served most recently as director of the Center for the Future of the Healthcare Workforce at New York Institute of Technology and as a senior fellow in Penn’s Leonard Davis Institute of Health Economics. Cooper began his clinical and investigative training in hematology and oncology in the 1960s at the National Cancer Institute and Boston City Hospital’s Thorndike Memorial Laboratory. He rose to be Thorndike’s chief of hematology as an assistant professor at the Harvard Medical School, then joined the Penn faculty in 1971. He returned to his home town of Milwaukee to serve as dean and executive vice president of the He served on several boards, including those of the Becket Fund for Religious Liberty, the Foreign Policy Research Institute, and the American Trauma Society. Templeton retired from medicine in 1995 to manage the Templeton foundation, established by his father, Sir John Templeton, the global investor and philanthropist. After the death of his father in 2008, Templeton became the foundation’s top executive. Under his leadership, the foundation’s endowment grew from $28 million to $3.34 billion. The foundation awards grants,

Medical College of Wisconsin from 1985 to 1994. Cooper also founded and directed its interdisciplinary Health Policy Institute (now the Institute for Health and Society) from 1994 to 2004. In the 1990s, Cooper’s health policy research helped change how the size of the U.S. health care work force is evaluated and how future physician needs are projected. When most of the nation’s leading physician supply experts were calling for a reduction in the physician work force because of a perceived surplus, Cooper correctly predicted a shortage of doctors within the next 20 years. According to Linda Aiken, Ph.D., R.N., the Claire M. Fagin Leadership Professor in Nursing at Penn and director of the Center for Health Outcomes and Policy Research, Cooper was an innovative thinker: “He was an early advocate for nurses taking on expanded responsibilities in primary care, and he published many influential papers providing evidence to support full scope of practice for advanced practice nurses.” Cooper was also a vocal critic of the Dartmouth Atlas of Health Care, which has documented variations in how medical resources are distributed and used in the United States. Shortly before he died, Cooper finished writing Poverty and the Myths of Health Care Reform: Why Poverty and Income Inequality Are at the Core of America’s High Health Care Spending. It is expected to be available from Johns Hopkins University Press in August 2016.

mainly to universities and scholars, and gives an annual $1.7 million Templeton Prize to honor a person who has made exceptional contributions to affirming life’s spiritual dimension, whether through insight, discovery, or practical works. In addition to papers published in medical journals, Templeton wrote two books, Thrift and Generosity: The Joy of Giving (2004), and A Searcher’s Life (2008). William J. Tuddenham. See Class of 1950.

Providing for Loved Ones and for the Perelman School of Medicine

“Penn gave me a full scholarship. There is no way I would have been able to afford such a great school without the wonderful financial support I received,” said Carol Herman Szarko, M.D. ’66, G.M.E. ’69. “When I started medical school, Penn guaranteed that no students would drop out for financial reasons; students would get the support and opportunities they needed to excel. Penn was good on their word.” Giving back to her medical alma mater was not a difficult decision. “I also trust Penn; the institution is strong and secure, and the medical school has been around for 250 years.” She was confident that setting up a charitable gift annuity for herself through Penn Medicine Planned Giving was the right choice to meet her philanthropic interests. She was so satisfied with the results, she set up an annuity for her sister and brother-in-law just a few years later. By designating the annuity to support medical scholarships, Dr. Szarko is thrilled to be able to “pay it forward,” in support of current and future students. “By using multiple appreciated stocks, I was able to simplify my stock holdings and reduce the number of statements I received,” she said in reference to her own charitable gift annuity. In many ways, setting up a gift annuity for her sister and brother-in-law through Penn Medicine was the missing piece of the puzzle. They are retired and living modestly. “When I learned more about their financial situation, I realized how they would benefit from reliable, monthly payments, so I established a gift annuity for them.” “Creating a planned gift, particularly a gift annuity, was an ideal way to provide guaranteed income to my family,” Dr. Szarko added. “It was uncomplicated to arrange and immensely rewarding, in terms of meeting my family’s needs and doing this through an institution to which I owe my personal gratitude.” Planned Giving has sometimes been described by our donors as the final piece of a puzzle. Figuring out how this important puzzle piece can work best for you, your family, and your philanthropic goals is what we do best. Speak with us to learn more about giving options and we will help you find the missing piece of your puzzle. Contact Christine S. Ewan, JD, executive director of Planned Giving, at 215-898-9486 or cewan@upenn.edu. For more information, please visit the website at: www.plannedgiving.med.upenn.edu.

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EDITOR’S NOTE

Near and Far This issue of Penn Medicine has articles on both the very near and the very far. The very far in this case is Liberia, about 4,650 miles away. That’s where one of the Perelman School’s alumnae, Venee Tubman, M.D. ’06, visits periodically to screen newborns for sickle cell disease and to offer treatment for affected children. The near is as near as one can get: the Penn campus and the city itself. But I must qualify that immediately: the Penn campus and the campus of our neighbor, the Children’s Hospital of Philadelphia. When Miriam Falco, who wrote our cover story on successful collaborations between Penn Medicine and CHOP, visited these two grand Philadelphia institutions last fall, she was struck by their proximity. Although she had been in the city on earlier occasions, this was the first time she appreciated how close Penn and CHOP actually were. To help her get a fuller sense of the environment, I took her on a brief walking tour. It included a visit to some older buildings, like the John Morgan Building (originally opened in 1904) and newer buildings, like the Perelman Center for Advanced Medicine (opened in 2008). From there, it was up a few stories to the Henry Jordan M’62 Medical Education Center, which officially opened last year. From its generously sized windows, we could view the surrounding area and the newest CHOP and Penn Medicine buildings that have dramatically changed the skyline of Civic Center Boulevard. On our walk, too, it did not escape her notice that HUP’s Silverstein Pavilion could shake hands with its close neighbor on 34th Street, the Main Building of Children’s Hospital. The setting for collaborations seems ideal. Also in the near category: our article on the Penn Center for Community Health Workers, which pairs high-risk patients in the surrounding communities with workers who help them to navigate the health system. The center’s work has and been covered in, among other places, The New York Times, NPR, and Forbes. In the article, one of the community health workers and his patient take the El to Reading Terminal Market to pick out some healthy fruits

and vegetables. You don’t get more Philly than that! Our last “near” article is on Penn’s patient portal, myPennMedicine. An example of cloud computing, mPM allows doctors and their staffs to communicate with patients and their families in a new, efficient way. At last estimate, about 240,000 people actively use the portal, and I count myself as one of its satisfied users. Back to very far. Dr. Tubman, a pediatric hematologist/oncologist at Dana-Farber/Boston Children’s Hospital, is very much a woman on the move, as our writer, Lori L. Ferguson, notes at the beginning of the article. Indeed, between her commitments in Boston and Liberia, pinning Tubman down for interviews and getting some stateside photographs was tricky. (She very nicely allowed us to run some photos that she had from Liberia.) Her ties to Liberia have historical roots: her grandfather was William Tubman, who served as the nation’s president from 1944 to 1971. He was called “the father of modern Liberia.” Of particular relevance for a granddaughter in medicine: Tubman had the streets of Monrovia, the capital, paved; had a public sanitation system installed; and ordered the construction of hospitals. As noted, Venee Tubman’s special mission in Liberia involves sickle cell disease. But she also told us that this inherited disorder, although much more common in Liberia, does affect Americans as well, and she is concerned that people are not as familiar with it here as they should be. When she says, “I’m truly passionate about delivering outstanding patient care and empowering people,” her actions speak as loudly as her words. She also gives credit to Penn for helping her to realize her potential. She is certainly making her medical school proud.

john.shea@uphs.upenn.edu

Keep in Touch:

In the Summer Issue: More Penn Med students are recognizing the role of spirituality in the care of patients and learning how to listen better to patients and their families. A program in which the students shadow hospital chaplains is becoming more popular.

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ONE LAST THOUGHT

And the Word Is . . .

Mustaches!

When several members of the plastic surgery division at HUP were searching for a way to raise money for a good cause last year, the idea came to take a break from shaving – at least the part above their lips. The beneficiary was the Movember Foundation, a global charity established in 2003, “committed to men living happier, healthier, longer lives.” As its site puts it, “Every Movember, we challenge men to grow and women to support a moustache or make a commitment to get active and MOVE for 30 days.” At Penn Med, Fares Samra, M.D., a plastic surgery resident, led the effort. “I have friends who have done this, so I spoke with some of my co-residents and we agreed it would be a fun way to raise money and awareness for a good cause,” he said. In the end, 22 male residents, fellows, and attending physicians took part and helped raise nearly $800 for the foundation. Mustaches also played a prominent role in another recent enterprise that included residents at Penn Med – the mustaches were featured in an article that appeared in the Christmas issue of The BMJ, an annual edition filled with lighter takes on scientific issue. The lead author is Mackenzie R. Wehner, M.D., M.Phil., a dermatology resident at the Perelman School. Another of the authors is Kevin T. Nead, M.D., M.Phil., a resident in radiation oncology and a fellow of the Leonard Davis Institute of Health Economics. But although treated lightly, the subject was serious:

“Plenty of Moustaches But Not Enough Women: Cross-Sectional Study of Medical Leaders.” Relying on photographs on the websites of top academic institutions in the United States, the researchers found 1,108 people who met the inclusion criteria – chairs, chiefs, or heads of each specialty at top academic institutions in the United States. Their findings: only 13 percent of those positions are held by women. On the other hand, nearly 20 percent are held by men with mustaches. The authors approached their task with obvious precision: “We defined a moustache as the visible presence of hair on the upper cutaneous lip and included both standalone moustaches (for example, Copstash Standard, Pencil, Handlebar, Dali, Supermario) as well as moustaches in combination with other facial hair (for example, Van Dyke, Balbo, The Zappa). . . . We evaluated each leader for the presence of facial hair regardless of sex.” Their conclusion, however, was definitely straightforward: “Two evidence-based solutions that could be applied to improve [the percentage of women as medical leaders] are the predefining of hiring criteria and innovations that allow women flexibility in scheduling their working days and years.” Editor’s note: Given that the B in The BMJ stands for British, the journal opts for the British spelling of mustache. Penn Medicine proudly choses the more common American spelling.

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This demonstration to raise consciousness about sickle cell disease might have taken place in an American city, but it occurred thousands of miles away. Find out more on page 18.